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200 Amelon Sq Madison Heights VA 24572-5981 | |
(434) 929-1095 | |
(434) 929-1098 |
Full Name | |
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Speciality | Family Medicine |
Location | 200 Amelon Sq, Madison Heights, Virginia |
Authorized Official Name and Position | Karen L Haynes (STAFF CREDENTIALING MANAGER) |
Authorized Official Contact | 4343821139 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 2489 Forest VA 24551-6489 Ph: (434) 382-1139 | 200 Amelon Sq Madison Heights VA 24572-5981 Ph: (434) 929-1095 |
NPI Number | 1225110737 |
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Provider Enumeration Date | 10/20/2006 |
Last Update Date | 06/19/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1225110737 | NPI | - | NPPES |
1225110737 | Other | VA | FACILITY CLOSED 06/14/2014 |
CO3658 | Other | VA | CVFP MCARE GROUP PTAN |
1528155892 | Other | VA | CVFP CORPORATE NPI |
1528155892 | Medicaid | VA | |
CA2436 | Other | VA | MEDICARE RAILROAD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |