1427290352 NPI number — JAMES RIVER FAMILY PRACTICE, LLC

Table of content: (NPI 1427290352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427290352 NPI number — JAMES RIVER FAMILY PRACTICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES RIVER FAMILY PRACTICE, LLC
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:
1427290352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2511 N HIATUS RD # 166
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33026-1301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-271-4091
Provider Business Mailing Address Fax Number:
888-818-1230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11835 FISHING POINT DR
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
NEWPORT NEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23606-2584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-599-5588
Provider Business Practice Location Address Fax Number:
757-599-6893
Provider Enumeration Date:
03/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KROETSCH
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
ROBERT DONALD
Authorized Official Title or Position:
REVENUE CYCLE MANAGER
Authorized Official Telephone Number:
888-360-2288

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: 1902899016 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1508086257 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1659301430 . This is a "ANTHEM BLUE CROSS AND BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14078914833 . This is a "ANTHEM BLUE CROSS AND BLUE SHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 14078914833 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1508086257 . This is a "ANTHEM BLUE CROSS AND BLUE SHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1659301430 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1902899016 . This is a "ANTHEM BLUE CROSS AN BLUE SHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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