Provider Demographics
NPI:1083754790
Name:PROFESSIONAL HEALTH CARE, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-732-0372
Mailing Address - Street 1:849 S SYCAMORE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-5801
Mailing Address - Country:US
Mailing Address - Phone:804-732-0372
Mailing Address - Fax:804-732-3435
Practice Address - Street 1:849 S SYCAMORE ST
Practice Address - Street 2:SUITE E
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5801
Practice Address - Country:US
Practice Address - Phone:804-732-0372
Practice Address - Fax:804-732-3435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08785OtherMEDICARE