GREATER PRINCE WILLIAM AREA COMMUNITY HEALTH CENTER INC (NPI# 1366591562) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366591562 |
| Entity Type | Organization |
| Organization Name | GREATER PRINCE WILLIAM AREA COMMUNITY HEALTH CENTER INC |
| Practice Address |
4379 Ridgewood Center Dr Suite 102 Woodbridge VA 22192-8322 |
| Practice Telephone | 0736807950 |
| Practice Fax Number | 7036807953 |
| Mailing Telephone | 7036807950 |
| Mailing Fax Number | 7036807953 |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2015-10-29 |
| Authorized Official Name | GEORGE BARKER (CEO) |
| Authorized Official Telephone | 7036708858 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 1366591562 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770914939 | Greater Prince William Area Community Health Center Inc | Clinic/Center | 9705 Liberia Ave, Manassas, VA 20110-1743 | 2013-12-12 |
| 1568838738 | Greater Prince William Area Community Health Center Inc | Clinic/Center | 17739 Main St, 130, Dumfries, VA 22026-3251 | 2015-08-11 |
| 1063748820 | Greater Prince William Area Community Health Center Inc | Clinic/Center | 9444 Taney Rd, Manassas, VA 20110-5933 | 2009-10-28 |
| Street Address |
4379 RIDGEWOOD CENTER DR SUITE 102 |
| City | WOODBRIDGE |
| State | VA |
| Zip Code | 22192-8322 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053303651 | Katie Lynne Kotopoulos | Nurse Practitioner | 4379 Ridgewood Center Dr, Suite 102, Woodbridge, VA 22192-8322 | 2005-08-19 |
| 1356828560 | Mary Hunnicutt | Counselor | 4379 Ridgewood Center Dr, Woodbridge, VA 22192-8322 | 2018-07-20 |
| 1427400639 | Matthew Lam | Dentist | 4379 Ridgewood Center Dr, Woodbridge, VA 22192-8322 | 2016-07-12 |
| 1831573575 | Afsaneh Samatha Shahidi | Dentist | 4379 Ridgewood Center Dr, Woodbridge, VA 22192-8322 | 2015-07-13 |
| 1710360029 | Amber Hasan | Dentist | 4379 Ridgewood Center Dr, Ste 102, Woodbridge, VA 22192-8322 | 2015-07-06 |
| 1689063687 | Mi-yon Choi | Dentist | 4379 Ridgewood Center Dr, Suite 102, Woodbridge, VA 22192-8322 | 2015-01-13 |
| 1275974156 | Sheetal Ray | Dentist | 4379 Ridgewood Center Dr, Ste 102, Woodbridge, VA 22192-8322 | 2013-07-09 |
| 1790125755 | Amparo Lizeth Pinzon Avellaneda | Dentist | 4379 Ridgewood Center Dr, Suite 102, Woodbridge, VA 22192-8322 | 2013-07-04 |
| 1992053466 | Alvaro Vargas | Counselor | 4379 Ridgewood Center Dr, Suite 102, Woodbridge, VA 22192-8322 | 2012-08-15 |
| 1972864940 | Anh Ngoc Pham | Physician Assistant | 4379 Ridgewood Center Dr, Suite 102, Woodbridge, VA 22192-8322 | 2012-06-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245873645 | Ursula Jackson | Technician | 3500 Commission Ct, Woodbridge, VA 22192 | 2019-10-18 |
| 1205480779 | Ki Soo Park | Physical Therapy Assistant | 12825 Minnieville Road Suite 201, Lake Ridge, VA 22192 | 2019-08-01 |
| 1801448329 | Karen Lee Trivett | Specialist/Technologist, Other | 12584 Darby Brook Court, Woodbridge, VA 22192 | 2019-07-15 |
| 1407313166 | Nichele Amelia Thompson | Behavioral Analyst | 2731 Marblestone Dr, 101, Woodbridge, VA 22192 | 2019-02-28 |
| 1952877870 | Kimberly Ann Rojas Vazquez | Behavioral Analyst | 12531 Clipper Dr, Suite 203, Woodbridge, VA 22192 | 2018-10-18 |
| 1104391614 | Ykim Dental | Dentist | 2680 Optiz Blvd., Suite 120, Woodbridge, VA 22192 | 2018-10-11 |
| 1013418755 | Arm Transport | Non-emergency Medical Transport (VAN) | 13000 Harbor Center Dr Ste 132d, Woodbridge, VA 22192 | 2018-02-27 |
| 1811496813 | Francesca Nasi | Behavioral Analyst | 12531 Clipper Dr Ste 203, Woodbridge, VA 22192 | 2018-02-05 |
| 1942729504 | Bismark Transportation Service LLC | Non-emergency Medical Transport (VAN) | 12341 Woodlawn Court, Woodbridge, VA 22192 | 2017-09-14 |
| 1992226344 | Arm Baby Eldery Home Health LLC | Home Health | 13000 Harbor Center Dr # 312c, Woodbridge, VA 22192 | 2017-07-06 |
| Find all providers in zip 22192 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942527874 | Greater Prince William Area Community Heatlh Center | Clinic/Center | 4379 Ridgewood Center Dr, Suite 102, Woodbridge, VA 22192-8322 | 2010-05-03 |
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| 1396256087 | Neighborhood Health | Clinic/Center | 1501 Cameron St, Alexandria, VA 22314-2702 | 2017-10-20 |
| 1689122186 | Monroe County Health Center Board of Trustees | Clinic/Center | 25239 Craigs Creek Rd, New Castle, VA 24127-6223 | 2016-09-14 |
| 1962950584 | Vernon J Harris East End Community Health Center | Clinic/Center | 1800 Lynhaven Ave, Richmond, VA 23224-7734 | 2016-09-12 |
| Find all providers with the same taxonomy | ||||
| City | WOODBRIDGE |
| Zip Code | 22192 |
Please comment or provide details below to improve the information on GREATER PRINCE WILLIAM AREA COMMUNITY HEALTH CENTER INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.