| Vcu Sports Medicine | |
|
1300 W Broad St Richmond VA 23284-9089 | |
| (804) 828-6315 | |
| Not Available |
| Full Name | Vcu Sports Medicine |
|---|---|
| Speciality | Clinic/center |
| Location | 1300 W Broad St, Richmond, Virginia |
| Authorized Official Name and Position | Dominic J Puleo (CFO) |
| Authorized Official Contact | 8048281295 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vcu Sports Medicine Po Box 758997 Baltimore MD 21275-0001 Ph: () - | Vcu Sports Medicine 1300 W Broad St Richmond VA 23284-9089 Ph: (804) 828-6315 |
| NPI Number | 1548317308 |
|---|---|
| Provider Enumeration Date | 01/04/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548317308 | NPI | - | NPPES |
| 180914 | Other | ANTHEM-VCU SPORTS MEDICIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | H1875 (Virginia) | Primary |
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