Provider Demographics
NPI:1003126756
Name:NOTTOWAY INNOVATIVE MEDICAL SOLUTIONS
Entity Type:Organization
Organization Name:NOTTOWAY INNOVATIVE MEDICAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINNERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-930-0046
Mailing Address - Street 1:1279 W 10TH ST STE 116
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:VA
Mailing Address - Zip Code:23824-3071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1279 W 10TH ST STE 116
Practice Address - Street 2:
Practice Address - City:BLACKSTONE
Practice Address - State:VA
Practice Address - Zip Code:23824-3071
Practice Address - Country:US
Practice Address - Phone:703-930-0046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty