Provider Demographics
NPI:1083776363
Name:HILLELSON-WHIPPLE CLINIC DBA AMERICAN SELF
Entity Type:Organization
Organization Name:HILLELSON-WHIPPLE CLINIC DBA AMERICAN SELF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:L
Authorized Official - Last Name:HILLELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:804-290-0060
Mailing Address - Street 1:9930 INDEPENDENCE PARK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1475
Mailing Address - Country:US
Mailing Address - Phone:804-290-0060
Mailing Address - Fax:804-290-0206
Practice Address - Street 1:9930 INDEPENDENCE PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233
Practice Address - Country:US
Practice Address - Phone:804-290-0060
Practice Address - Fax:804-290-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021093207X00000X
VA0101034668208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty