1225110737 NPI number — CENTRAL VIRGINIA FAMILY PHYSICIANS INC

Table of content: (NPI 1225110737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225110737 NPI number — CENTRAL VIRGINIA FAMILY PHYSICIANS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL VIRGINIA FAMILY PHYSICIANS INC
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:
CVFP AMELON IMMEDIATE CARE
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:
1225110737
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2489
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24551-6489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-382-1139
Provider Business Mailing Address Fax Number:
434-525-5748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 AMELON SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON HEIGHTS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24572-5981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-929-1095
Provider Business Practice Location Address Fax Number:
434-929-1098
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAYNES
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
STAFF CREDENTIALING MANAGER
Authorized Official Telephone Number:
434-382-1139

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1225110737 . This is a "FACILITY CLOSED 06/14/2014" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: CO3658 . This is a "CVFP MCARE GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1528155892 . This is a "CVFP CORPORATE NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1528155892 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CA2436 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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