| |
610 Park Avenue Nw Norton VA 24273 | |
(276) 321-7866 | |
(276) 321-7843 |
Full Name | |
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Speciality | Family Medicine |
Location | 610 Park Avenue Nw, Norton, Virginia |
Authorized Official Name and Position | Vijay Kumar (CEO) |
Authorized Official Contact | 4239439415 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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610 Park Avenue Nw Norton VA 24273 Ph: (276) 325-0121 | 610 Park Avenue Nw Norton VA 24273 Ph: (276) 321-7866 |
NPI Number | 1053839977 |
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Provider Enumeration Date | 08/30/2017 |
Last Update Date | 01/06/2025 |
Medicare PECOS PAC ID | 9830455880 |
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Medicare Enrollment ID | O20171108002048 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053839977 | NPI | - | NPPES |
0101243187 | Other | VA | LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Vijay N Kumar |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1477747145 PECOS PAC ID: 5597839167 Enrollment ID: I20080730000432 |
Community Physicians Services Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 96 15th St Nw, Ste 104, Norton, VA 24273 Phone: 276-679-8890 Fax: 276-679-9740 | |
Shahab M. Ehtesham Md Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 611 Trent St Ne, Norton, VA 24273 Phone: 276-679-4200 Fax: 276-679-4230 | |