Provider Demographics
NPI:1043217912
Name:CHICKAHOMINY FAMILY
Entity Type:Organization
Organization Name:CHICKAHOMINY FAMILY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:K
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-932-4388
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:QUINTON
Mailing Address - State:VA
Mailing Address - Zip Code:23141-0007
Mailing Address - Country:US
Mailing Address - Phone:804-932-4388
Mailing Address - Fax:804-932-9860
Practice Address - Street 1:2500 NEW KENT HWY
Practice Address - Street 2:
Practice Address - City:QUINTON
Practice Address - State:VA
Practice Address - Zip Code:23141-1735
Practice Address - Country:US
Practice Address - Phone:804-932-4388
Practice Address - Fax:804-932-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA065167OtherBCBS
VA057298OtherBCBS
VA5622557Medicaid
VA065167OtherBCBS
VAC04361Medicare ID - Type Unspecified
5623251Medicare ID - Type Unspecified
VA057298OtherBCBS
Q29046Medicare UPIN
B63981Medicare UPIN
VA5622557Medicaid