| Cleanslate Medical Group Of Virginia, Llc | |
|
8220 Meadowbridge Rd Ste 310 Mechanicsville VA 23116-2340 | |
| (804) 417-0120 | |
| (804) 277-3029 |
| Full Name | Cleanslate Medical Group Of Virginia, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 8220 Meadowbridge Rd Ste 310, Mechanicsville, Virginia |
| Authorized Official Name and Position | Matthew Philip Smolarek (CFO) |
| Authorized Official Contact | 4129995188 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cleanslate Medical Group Of Virginia, Llc 8 Cadillac Dr Ste 180 Brentwood TN 37027-5393 Ph: (615) 425-0220 | Cleanslate Medical Group Of Virginia, Llc 8220 Meadowbridge Rd Ste 310 Mechanicsville VA 23116-2340 Ph: (804) 417-0120 |
| NPI Number | 1629549779 |
|---|---|
| Provider Enumeration Date | 12/16/2018 |
| Last Update Date | 07/03/2024 |
| Medicare PECOS PAC ID | 9133462294 |
|---|---|
| Medicare Enrollment ID | O20190514000779 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629549779 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 207RA0401X | Internal Medicine - Addiction Medicine | (* (Not Available)) | Primary |
| Provider Name | Helen Habtemichael |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235320854 PECOS PAC ID: 6103904412 Enrollment ID: I20080425000522 |
| Provider Name | Shannon R Davidson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053571562 PECOS PAC ID: 0446430383 Enrollment ID: I20110209000375 |
| Provider Name | Bishoy T Samuel |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1659506624 PECOS PAC ID: 4880902915 Enrollment ID: I20221122000425 |
| Provider Name | Parth A Saraiya |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1124482583 PECOS PAC ID: 3971897299 Enrollment ID: I20230315000869 |
| Provider Name | Tipree D Graves |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1780469429 PECOS PAC ID: 1254782691 Enrollment ID: I20240110000490 |
| Provider Name | Melissa R King |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578269940 PECOS PAC ID: 0446601561 Enrollment ID: I20240112001403 |
| Provider Name | Satkiran Grewal |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1356421085 PECOS PAC ID: 3678592060 Enrollment ID: I20240208004628 |
| Provider Name | Edward W Berry |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336700129 PECOS PAC ID: 7315383536 Enrollment ID: I20240311002232 |
The Bon Secours Program For Diabetes Health - Memorial Regional Medica Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8220 Meadowbridge Rd Ste 203, Mechanicsville, VA 23116 Phone: 804-764-7885 Fax: 804-559-6185 | |
Peter L. Goodman, M. D.,inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8220 Meadowbridge Rd, Suite 301, Mechanicsville, VA 23116 Phone: 804-559-0423 Fax: 804-559-1260 | |
Bon Secours Primary Care Associates - Mechanicsville Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7041 Lee Park Rd, Mechanicsville, VA 23111 Phone: 804-746-3505 Fax: 804-730-8038 | |
Atlantic Knee Restoration & Regenerative Medicine - Richmond Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 7481 Right Flank Rd Ste 100, Mechanicsville, VA 23116 Phone: 256-302-2228 | |
Primedoc Of Richmond Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 8260 Atlee Rd, Mechanicsville, VA 23116 Phone: 843-237-3378 Fax: 843-237-5073 | |
Orthovirginia, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8200 Meadowbridge Road, Suite 100, Mechanicsville, VA 23116 Phone: 804-730-2121 Fax: 804-730-0563 | |
Richmond Diabetes And Endocrinology - Bon Secours Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8266 Atlee Rd Ste 332, Mechanicsville, VA 23116 Phone: 804-764-7686 Fax: 804-764-7689 |