GUADALUPE FREE CLINIC; NPI #1417778275

Contact Information

GUADALUPE FREE CLINIC

700 MCKINNEY BLVD STE 1100
COLONIAL BEACH, VA 22443-1934

Phone: 804-224-0571
Fax: 804-224-0572
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Clinic Pharmacy	3336C0002X	58	Medical Supply Company with Pharmacist

Indicates primary specialty

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NPI Profile & details for GUADALUPE FREE CLINIC

NPI # 1417778275

LBN Legal business name GUADALUPE FREE CLINIC

Authorized official DANIEL MULDOON - (MEDICAL DIRECTOR)

Entity Organization

Organization subpart ¹ No

Enumeration date 10/23/2024

Last updated 10/23/2024 - More than a year ago

Identifiers

VA	Other	0201004142	VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS, BOARD OF PHARMACY
VA	Other	C65	VIRGINIA IMMUNIZATION INFORMATION SYSTEM

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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