| Pedsplus Primary Care | |
|
1300 Emancipation Hwy Fredericksburg VA 22401-4600 | |
| (540) 289-2273 | |
| (540) 699-0214 |
| Full Name | Pedsplus Primary Care |
|---|---|
| Speciality | Family Medicine |
| Location | 1300 Emancipation Hwy, Fredericksburg, Virginia |
| Authorized Official Name and Position | Mickelina Laurore (MANAGER) |
| Authorized Official Contact | 2396915450 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pedsplus Primary Care 1010 W Kensington Cir Fredericksburg VA 22401-8003 Ph: (239) 691-5450 | Pedsplus Primary Care 1300 Emancipation Hwy Fredericksburg VA 22401-4600 Ph: (540) 289-2273 |
| NPI Number | 1497106504 |
|---|---|
| Provider Enumeration Date | 06/29/2016 |
| Last Update Date | 12/30/2022 |
| Medicare PECOS PAC ID | 1254691173 |
|---|---|
| Medicare Enrollment ID | O20180213003028 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497106504 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Virginia) | Primary |
| Provider Name | Jean Y Laurore |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1053578856 PECOS PAC ID: 5991870495 Enrollment ID: I20080819000071 |
| Provider Name | Mickelina L Laurore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275908006 PECOS PAC ID: 2668777194 Enrollment ID: I20160222001884 |
| Provider Name | Michael Edward Perraut |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1013042209 PECOS PAC ID: 9436244639 Enrollment ID: I20180305000399 |
| Provider Name | Tore Michelle Flavin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427680693 PECOS PAC ID: 5092136309 Enrollment ID: I20200521002426 |
| Provider Name | Tammy Lynn Maniscalco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447722871 PECOS PAC ID: 9739500067 Enrollment ID: I20200522000221 |
| Provider Name | Mary Jean Eller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609446269 PECOS PAC ID: 0345639936 Enrollment ID: I20211122000568 |
| Provider Name | Lori Jean Sprouse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629798681 PECOS PAC ID: 5698132181 Enrollment ID: I20230526000364 |
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