Provider Demographics
NPI:1053687285
Name:DLP TWIN COUNTY PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:DLP TWIN COUNTY PHYSICIAN PRACTICES LLC
Other - Org Name:INDEPENDENCE FAMILY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:217 S INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:VA
Mailing Address - Zip Code:24348-2802
Mailing Address - Country:US
Mailing Address - Phone:276-236-0065
Mailing Address - Fax:
Practice Address - Street 1:217 S INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:VA
Practice Address - Zip Code:24348-2802
Practice Address - Country:US
Practice Address - Phone:276-236-0065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty