1457560997 NPI number — RHEUMATOLOGY ASSOCIATES OF CENTRAL VIRGINIA LLC

Table of content: (NPI 1457560997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457560997 NPI number — RHEUMATOLOGY ASSOCIATES OF CENTRAL VIRGINIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RHEUMATOLOGY ASSOCIATES OF CENTRAL VIRGINIA LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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NPI Number Information

NPI Number:
1457560997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2216 PRINCESS ANNE ST
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
FREDERICKSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22401-3300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-899-1354
Provider Business Mailing Address Fax Number:
540-899-3599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2216 PRINCESS ANNE ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22401-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-899-1354
Provider Business Practice Location Address Fax Number:
540-899-3599
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LIVELY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
540-741-1411

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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