NPIMap

Organization Active NPI

Rockbridge Area Free Clinic

Doing business as Maury River Middle School Health Center

  • Federally Qualified Health Center (FQHC)
  • Lexington, VA
National Provider Identifier
1780465468
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ROCKBRIDGE AREA FREE CLINIC
Doing business as
Maury River Middle School Health Center
Practice address
600 Waddell St
Lexington, VA 24450-2267
Phone
(540) 464-8700
NPI assigned
Oct 10, 2023
Last updated
Oct 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Authorized official

Name
Valerie Suzanne Sheridan
Title
Ceo
Phone
(540) 464-8700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

600 Waddell St
Lexington, VA 24450-2267

Mailing address

25 Northridge LN
Lexington, VA 24450-3399
Phone (540) 464-8700

Other names 1

  • Maury River Middle School Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240109001093 VA Part A Provider - Federally Qualified Health Center (FQHC) 2860626231 Practice locations: Lexington, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780465468. Details of each certification follow.

Federally qualified health center certification: CCN 491018

Legal name
ROCKBRIDGE AREA FREE CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 9, 2024
Last certification
Jan 9, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 18, 1992 in VA
Enrollment address
600 Waddell St
Lexington, VA 24450-2267

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2307508Maury River Middle School Health Center600 Waddell Street, Lexington, VA 24450Certificate of waiverJul 9, 2028

National Provider Directory

National Provider Directory
Tax ID family
Rockbridge Area Free Clinic6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

170 Kendal Dr
#A
Lexington, VA 24450
Phone (540) 464-8700

600 Waddell St
Lexington, VA 24450
Phone (540) 464-8700

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Patricia Jones Individual Corporate Officer May 1, 2017
Jane T Horton Individual Corporate Officer May 1, 2015
David a Dugan Individual Corporate Officer May 1, 2020
Valerie Suzanne Sheridan Individual Corporate Officer Feb 20, 2014
Operational/Managerial Control Feb 20, 2014
Dennis Cropper Individual Corporate Officer May 1, 2019

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1696896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696896000000",
    "number": "1780465468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 NORTHRIDGE LN",
            "city": "LEXINGTON",
            "state": "VA",
            "postal_code": "244503399",
            "telephone_number": "540-464-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 WADDELL ST",
            "city": "LEXINGTON",
            "state": "VA",
            "postal_code": "244502267",
            "telephone_number": "540-464-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKBRIDGE AREA FREE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-10",
        "last_updated": "2023-10-10",
        "certification_date": "2022-10-26",
        "status": "A",
        "authorized_official_last_name": "SHERIDAN",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_middle_name": "SUZANNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "540-464-8700"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maury River Middle School Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lexington, VA

Sources for this page

Verify at the official NPI Registry.