| Infectious Disease Specialists Pc | |
|
7605 Forest Ave Suite 410 Richmond VA 23229-4938 | |
| (804) 285-1833 | |
| (804) 285-5754 |
| Full Name | Infectious Disease Specialists Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 7605 Forest Ave, Richmond, Virginia |
| Authorized Official Name and Position | James W Brooks (PRESIDENT) |
| Authorized Official Contact | 8042851833 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Infectious Disease Specialists Pc Po Box 11768 Richmond VA 23230-0168 Ph: (804) 672-4835 | Infectious Disease Specialists Pc 7605 Forest Ave Suite 410 Richmond VA 23229-4938 Ph: (804) 285-1833 |
| NPI Number | 1649239476 |
|---|---|
| Provider Enumeration Date | 03/21/2006 |
| Last Update Date | 03/18/2010 |
| Medicare PECOS PAC ID | 8729090352 |
|---|---|
| Medicare Enrollment ID | O20060626000154 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649239476 | NPI | - | NPPES |
| C06304 | Other | GROUP MEDICARE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Hyunsun D Ko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952312258 PECOS PAC ID: 6901885615 Enrollment ID: I20040716000200 |
| Provider Name | Antonio Victor Prudente Gonzalez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073781142 PECOS PAC ID: 3173696705 Enrollment ID: I20080715000809 |
| Provider Name | James W Brooks |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1588633168 PECOS PAC ID: 9436275237 Enrollment ID: I20100929001372 |
| Provider Name | David M Rowles |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1205805785 PECOS PAC ID: 7012100407 Enrollment ID: I20101018001057 |
| Provider Name | Christina Marie Brockwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255906178 PECOS PAC ID: 6800299934 Enrollment ID: I20210727000498 |
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