1194163683 NPI number — BECKWITH MEDICAL GROUP, PLLC

Table of content: (NPI 1194163683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194163683 NPI number — BECKWITH MEDICAL GROUP, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BECKWITH MEDICAL GROUP, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED URGENT CARE OF LEESBURG
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194163683
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
952 EDWARDS FERRY RD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20176-3324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-379-7776
Provider Business Mailing Address Fax Number:
240-379-7787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
952 EDWARDS FERRY RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20176-3324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-379-7776
Provider Business Practice Location Address Fax Number:
240-378-7787
Provider Enumeration Date:
06/06/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOLDEN
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
240-379-7776

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)