1215926332 NPI number — RICHMOND PEDIATRIC SURGEONS LLC

Table of content: (NPI 1215926332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215926332 NPI number — RICHMOND PEDIATRIC SURGEONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHMOND PEDIATRIC SURGEONS 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:
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:
1215926332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 HEALTH PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-4525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-373-7600
Provider Business Mailing Address Fax Number:
866-346-1426

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7115 JAHNKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23225-4017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-828-6727
Provider Business Practice Location Address Fax Number:
804-228-6730
Provider Enumeration Date:
10/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
TEDRICK
Authorized Official Title or Position:
GROUP VP/AO
Authorized Official Telephone Number:
615-372-3375

Provider Taxonomy Codes

  • Taxonomy code: 2086S0120X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com