Provider Demographics
NPI:1043275977
Name:VIRGINIA UROLOGY CENTER
Entity Type:Organization
Organization Name:VIRGINIA UROLOGY CENTER
Other - Org Name:VIRGINIA UROLOGY-HANOVER DME
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-330-9105
Mailing Address - Street 1:9101 STONY POINT PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-2002
Mailing Address - Country:US
Mailing Address - Phone:804-287-1030
Mailing Address - Fax:804-288-3529
Practice Address - Street 1:8152 PLEASANT GROVE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2343
Practice Address - Country:US
Practice Address - Phone:804-730-5023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332900000X
VA0419750002332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0419750002Medicare NSC