Provider Demographics
NPI:1033108857
Name:ABINGDON FAMILY PRACTICE PC
Entity Type:Organization
Organization Name:ABINGDON FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:P
Authorized Official - Last Name:PENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-628-1186
Mailing Address - Street 1:617 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-9700
Mailing Address - Country:US
Mailing Address - Phone:276-628-1186
Mailing Address - Fax:276-628-8507
Practice Address - Street 1:617 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-9700
Practice Address - Country:US
Practice Address - Phone:276-628-1186
Practice Address - Fax:276-628-8507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005607531Medicaid
VA5752880001OtherMEDICARE NCS
VA005641802Medicaid
VA005642507Medicaid
064411OtherANTHEM
5603067OtherAETNA
2102748OtherMAMSI
460464OtherANTHEM
5756306OtherAETNA
VAC03006OtherMEDICARE PROVIDER
226900OtherANTHEM
3054602OtherBLUE CLASSIE
VAC03006OtherMEDICARE PROVIDER
5603067OtherAETNA
5756306OtherAETNA
=========03OtherJOHN DEERE
VA5752880001OtherMEDICARE NCS
5756306OtherAETNA
G34737Medicare UPIN
VA005642507Medicaid
VA005607531Medicaid