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4262 S Amherst Hwy Madison Heights VA 24572-5363 | |
(434) 846-8421 | |
(434) 846-2655 |
Full Name | |
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Speciality | Family Medicine |
Location | 4262 S Amherst Hwy, Madison Heights, Virginia |
Authorized Official Name and Position | Karen L Haynes (STAFF CREDENTIALING MANAGER) |
Authorized Official Contact | 4343821139 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 2489 Forest VA 24551-6489 Ph: (434) 382-1139 | 4262 S Amherst Hwy Madison Heights VA 24572-5363 Ph: (434) 846-8421 |
NPI Number | 1366520405 |
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Provider Enumeration Date | 11/02/2006 |
Last Update Date | 11/28/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366520405 | NPI | - | NPPES |
0907130011 | Other | MEDICARE DME | |
CC2392 | Other | VA | MEDICARE RAILROAD |
CO3658 | Other | VA | CVFP MCARE GROUP PTAN |
1528155892 | Other | VA | CVFP CORPORATE NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |