1215940507 NPI number — CHILDREN'S MEDICAL GROUP, INC., D/B/A COURTHOUSE PEDIATRICS

Table of content: (NPI 1215940507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215940507 NPI number — CHILDREN'S MEDICAL GROUP, INC., D/B/A COURTHOUSE PEDIATRICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S MEDICAL GROUP, INC., D/B/A COURTHOUSE PEDIATRICS
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:
Provider Other Organization Name Type Code:
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:
1215940507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLOUCESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23061-0800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-695-0305
Provider Business Mailing Address Fax Number:
804-695-0804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8264 GEORGE WASHINGTON MEMORIAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLOUCESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23061-4127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-695-0305
Provider Business Practice Location Address Fax Number:
804-695-0804
Provider Enumeration Date:
08/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ABSHIRE
Authorized Official First Name:
KATHRYN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SENIOR VP/CFO
Authorized Official Telephone Number:
757-668-8565

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  0101026966 , 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)





Copyright © 2007-2024 www.npivalidator.com