| |
505 West Leigh St Suite 301 Richmond VA 23220 | |
(804) 780-3008 | |
(804) 780-3014 |
Full Name | |
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Speciality | Family Medicine |
Location | 505 West Leigh St, Richmond, Virginia |
Authorized Official Name and Position | Wiley Jacob Latham (PARTNER) |
Authorized Official Contact | 8047803008 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 15483 Richmond VA 23227-0000 Ph: (804) 780-3008 | 505 West Leigh St Suite 301 Richmond VA 23220 Ph: (804) 780-3008 |
NPI Number | 1144332727 |
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Provider Enumeration Date | 08/31/2006 |
Last Update Date | 10/01/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1144332727 | NPI | - | NPPES |
5671051 | Medicaid | VA | |
6071066 | Medicaid | VA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 0101023261 (Virginia) | Primary |
207RG0100X | Internal Medicine - Gastroenterology | 0101023313 (Virginia) | Secondary |
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 | |