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7660 E Parham Road Suite 204 Richmond VA 23294 | |
(804) 364-8802 | |
(804) 364-1288 |
Full Name | |
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Speciality | Internal Medicine |
Location | 7660 E Parham Road, Richmond, Virginia |
Authorized Official Name and Position | Gregory Itskovich (VICE PRESIDENT) |
Authorized Official Contact | 8043648802 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 28645 Richmond VA 23228 Ph: (804) 364-8802 | 7660 E Parham Road Suite 204 Richmond VA 23294 Ph: (804) 364-8802 |
NPI Number | 1003901257 |
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Provider Enumeration Date | 10/04/2006 |
Last Update Date | 11/30/2007 |
Medicare PECOS PAC ID | 4688799000 |
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Medicare Enrollment ID | O20100908001063 |
Identifier | Type | State | Issuer |
---|---|---|---|
1003901257 | NPI | - | NPPES |
5863848 | Medicaid | VA | |
1291545964657 | Other | VA | AETNA |
258592 | Other | VA | ANTHEM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 0101058429 (Virginia) | Primary |
Provider Name | Rozana Itskovich |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1386829232 PECOS PAC ID: 1658495213 Enrollment ID: I20100902000998 |
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 | |