| Dominion Medical Associates, Inc | |
|
304 E Leigh St Richmond VA 23219-1410 | |
| (804) 225-7148 | |
| (804) 225-7159 |
| Full Name | Dominion Medical Associates, Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 304 E Leigh St, Richmond, Virginia |
| Authorized Official Name and Position | Richard Allen Jackson (PRESEND) |
| Authorized Official Contact | 8042257148 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dominion Medical Associates, Inc Po Box 5449 304 East Leigh Street Richmond VA 23220-0449 Ph: (804) 225-7148 | Dominion Medical Associates, Inc 304 E Leigh St Richmond VA 23219-1410 Ph: (804) 225-7148 |
| NPI Number | 1396826046 |
|---|---|
| Provider Enumeration Date | 10/18/2006 |
| Last Update Date | 05/30/2008 |
| Medicare PECOS PAC ID | 6406747609 |
|---|---|
| Medicare Enrollment ID | O20040428001282 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396826046 | NPI | - | NPPES |
| 1396826046 | Other | VA | NPI GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Damien L Covington |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316912991 PECOS PAC ID: 7618876772 Enrollment ID: I20040107000765 |
| Provider Name | Richard A Jackson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578644290 PECOS PAC ID: 2961497094 Enrollment ID: I20040419000366 |
| Provider Name | Tasha B Dickerson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255412052 PECOS PAC ID: 3476571860 Enrollment ID: I20051103001021 |
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