1659601250 NPI number — SPRY INSIDE FAMILY MEDICINE

Table of content: MICHAEL LARKIN MULLIGAN DPT (NPI 1235810797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659601250 NPI number — SPRY INSIDE FAMILY MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPRY INSIDE FAMILY MEDICINE
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:
1659601250
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3004 QUAIL WALK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN ALLEN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23059-5220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-920-0690
Provider Business Mailing Address Fax Number:
804-288-5211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2008 BREMO RD
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23226-2443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-288-1152
Provider Business Practice Location Address Fax Number:
804-288-5211
Provider Enumeration Date:
01/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
BRONWYN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
804-288-1152

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0104001914 , 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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