1194163683 NPI number — BECKWITH MEDICAL GROUP, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194163683 NPI number — BECKWITH MEDICAL GROUP, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BECKWITH MEDICAL 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:
ADVANCED URGENT CARE OF LEESBURG
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:
1194163683
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
952 EDWARDS FERRY RD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20176-3324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-379-7776
Provider Business Mailing Address Fax Number:
240-379-7787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
952 EDWARDS FERRY RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20176-3324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-379-7776
Provider Business Practice Location Address Fax Number:
240-378-7787
Provider Enumeration Date:
06/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDEN
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
240-379-7776

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , 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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