| Ivy Comprehensive Care Llc | |
|
2 Boars Head Pl Ste 110 Charlottesville VA 22903-4678 | |
| (434) 305-5955 | |
| (434) 956-3133 |
| Full Name | Ivy Comprehensive Care Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2 Boars Head Pl Ste 110, Charlottesville, Virginia |
| Authorized Official Name and Position | Marisa Christensen (OWNER) |
| Authorized Official Contact | 4343055955 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivy Comprehensive Care Llc 2 Boars Head Pl Ste 110 Charlottesville VA 22903-4678 Ph: (434) 305-5955 | Ivy Comprehensive Care Llc 2 Boars Head Pl Ste 110 Charlottesville VA 22903-4678 Ph: (434) 305-5955 |
| NPI Number | 1871094821 |
|---|---|
| Provider Enumeration Date | 02/26/2018 |
| Last Update Date | 08/21/2020 |
| Medicare PECOS PAC ID | 9638432073 |
|---|---|
| Medicare Enrollment ID | O20180417000803 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871094821 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| Provider Name | Marisa D Christensen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417049974 PECOS PAC ID: 1456381193 Enrollment ID: I20050812000799 |
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