Free Clinic of the New River Valley Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

FREE CLINIC OF THE NEW RIVER VALLEY INC

Doing business as

Clinic Annex Montgomery

Practice address

209 Roanoke St Ste 4
Christiansburg, VA 24073-3035

Phone

(540) 381-0820

NPI assigned

May 15, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michelle Brauns

Title

Executive Director

Phone

(540) 381-0820

Specialties & licenses 1

Addresses

Other names 1

• Clinic Annex Montgomery Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 491985

Legal name

COMMUNITY CENTER OF THE NEW RIVER VALLEY

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 11, 2022

Last certification

Feb 11, 2022

Ownership / control type

For profit – corporation

Facility address

209 Roanoke St, Ste 4
Christiansburg, VA 24073

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621036800000",
    "number": "1396319240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 ROANOKE ST",
            "city": "CHRISTIANSBURG",
            "state": "VA",
            "postal_code": "240733025",
            "telephone_number": "540-381-0820",
            "fax_number": "540-382-3391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 ROANOKE ST STE 4",
            "city": "CHRISTIANSBURG",
            "state": "VA",
            "postal_code": "240733035",
            "telephone_number": "540-381-0820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREE CLINIC OF THE NEW RIVER VALLEY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-15",
        "last_updated": "2021-05-15",
        "certification_date": "2021-04-23",
        "status": "A",
        "authorized_official_last_name": "BRAUNS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "540-381-0820"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinic Annex Montgomery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Denis Alemka Foretia, MD
• Dawn N Fouse, P.A.
• Nathan Callahan Foust, QMHA
• Free Clinic of the New River Valley
• Free Clinic of the New River Valley Inc
• Freedom Chiropractic L.L.C.
• Freedom Support Services
• April Furrow
• Galax Treatment Center, LLC
• Makenzi Gallagher, OTR/L

• Federally Qualified Health Center (FQHC) in Christiansburg, VA
• Providers in Christiansburg, VA by specialty
• Federally Qualified Health Center (FQHC) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.