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12320 W Broad St Ste 204 Richmond VA 23233 | |
(804) 612-2980 | |
(804) 762-7102 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 12320 W Broad St Ste 204, Richmond, Virginia |
Authorized Official Name and Position | Stephan Quiriconi (CFO) |
Authorized Official Contact | 8042818301 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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8580 Magellan Pkwy Richmond VA 23227-1149 Ph: () - | 12320 W Broad St Ste 204 Richmond VA 23233 Ph: (804) 612-2980 |
NPI Number | 1124532239 |
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Provider Enumeration Date | 11/28/2017 |
Last Update Date | 08/30/2019 |
Identifier | Type | State | Issuer |
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1124532239 | NPI | - | NPPES |
C06778 | Other | VA | MEDICARE PTAN |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Mary Brantley Holmes Msn Whnp-bc Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 8955 Wishart Rd, Richmond, VA 23229 Phone: 804-928-5596 | |
Independent Associates Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 7605 Forest Ave, Ste 211, Richmond, VA 23229 Phone: 804-282-3114 Fax: 804-285-9723 | |