Provider Demographics
NPI:1013187947
Name:KEMPSVILLE PRIMARY MEDICAL CARE CENTER INC
Entity Type:Organization
Organization Name:KEMPSVILLE PRIMARY MEDICAL CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSUE
Authorized Official - Middle Name:APILAN
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-473-0003
Mailing Address - Street 1:5136 PRINCESS ANNE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BCH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4228
Mailing Address - Country:US
Mailing Address - Phone:757-473-0003
Mailing Address - Fax:757-497-9510
Practice Address - Street 1:5136 PRINCESS ANNE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BCH
Practice Address - State:VA
Practice Address - Zip Code:23462-4228
Practice Address - Country:US
Practice Address - Phone:757-473-0003
Practice Address - Fax:757-497-9510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034998261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7320256Medicaid
VAB09645Medicare UPIN