Provider Demographics
NPI:1033150115
Name:BEDFORD FAMILY URGENT CARE, INC
Entity Type:Organization
Organization Name:BEDFORD FAMILY URGENT CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-587-8612
Mailing Address - Street 1:1368 AMERICAN WAY COURT
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-2940
Mailing Address - Country:US
Mailing Address - Phone:540-587-8612
Mailing Address - Fax:540-587-8619
Practice Address - Street 1:1368 AMERICAN WAY COURT
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-2940
Practice Address - Country:US
Practice Address - Phone:540-587-8612
Practice Address - Fax:540-587-8619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010141681Medicaid
VAE64583Medicare UPIN
VAC09399Medicare PIN