| Sandy River Family Care Inc | |
|
4520 Medical Center Rd Axton VA 24054-2822 | |
| (434) 685-7095 | |
| (434) 797-1300 |
| Full Name | Sandy River Family Care Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 4520 Medical Center Rd, Axton, Virginia |
| Authorized Official Name and Position | Rajendra S Trivedi (PRESIDENT) |
| Authorized Official Contact | 4346857095 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sandy River Family Care Inc 309 S Main St Danville VA 24541-2925 Ph: (434) 797-4150 | Sandy River Family Care Inc 4520 Medical Center Rd Axton VA 24054-2822 Ph: (434) 685-7095 |
| NPI Number | 1932354222 |
|---|---|
| Provider Enumeration Date | 12/01/2008 |
| Last Update Date | 09/10/2013 |
| Medicare PECOS PAC ID | 4688724024 |
|---|---|
| Medicare Enrollment ID | O20090605000489 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932354222 | NPI | - | NPPES |
| CL9316 | Other | VA | PALMETTO GBA MEDICARE |
| 258015 | Other | VA | ANTHEM BC |
| 005619505 | Medicaid | VA | |
| 89063VU | Other | NC | MEDICAID NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0101053147 (Virginia) | Primary |
| Provider Name | Vanessa P Hairston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295924538 PECOS PAC ID: 3476509183 Enrollment ID: I20050325000227 |
| Provider Name | Rajendra S Trivedi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740222843 PECOS PAC ID: 6800810953 Enrollment ID: I20080408000864 |
Central Piedmont Health Services, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4520 Medical Center Rd, Axton, VA 24054 Phone: 434-685-7095 Fax: 434-792-7385 |