1285773556 NPI number — ON-SITE PHYSICIANS GROUP, PLLC

Table of content: (NPI 1285773556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285773556 NPI number — ON-SITE PHYSICIANS GROUP, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ON-SITE PHYSICIANS 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:
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:
1285773556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12109 HOGANS ALY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23836-8611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-266-9666
Provider Business Mailing Address Fax Number:
804-681-0229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
561 N AIRPORT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND SPRINGS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23075-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-737-0172
Provider Business Practice Location Address Fax Number:
804-328-1073
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MUGHAL
Authorized Official First Name:
AMJAD
Authorized Official Middle Name:
I
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
804-266-9666

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  0101234398 , 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)





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