1023565496 NPI number — UNIVERSITY OF VIRGINIA PHYSICIANS GROUP

Table of content: (NPI 1023565496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023565496 NPI number — UNIVERSITY OF VIRGINIA PHYSICIANS GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF VIRGINIA PHYSICIANS GROUP
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:
6
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:
1023565496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9007
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22906-9007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-295-1000
Provider Business Mailing Address Fax Number:
434-972-4266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
541 SUNSET LN STE 303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CULPEPER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22701-3979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-321-3139
Provider Business Practice Location Address Fax Number:
540-321-3138
Provider Enumeration Date:
09/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
JUST
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
434-972-4285

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , 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)

  • Identifier: 1578685475 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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