1619176872 NPI number — JAMES RIVER PEDIATRICS PC

Table of content: (NPI 1619176872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619176872 NPI number — JAMES RIVER PEDIATRICS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES RIVER PEDIATRICS PC
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:
1619176872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1521 HUGUENOT RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
MIDLOTHIAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23113-2474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-794-1072
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1521 HUGUENOT RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MIDLOTHIAN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23113-2474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-794-1072
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZACHARY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
804-794-1072

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 818402 . This is a "MAMSI GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 082365 . This is a "BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1022006 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 285503 . This is a "SOUTHERN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 818403 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0753949 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8114312 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 087261 . This is a "BC/BS GROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 289596 . This is a "BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4511327 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 677345 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 747879 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7947576 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 06797725 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 76893 . This is a "VA PREMIER" identifier . This identifiers is of the category "OTHER".




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