Provider Demographics
NPI:1083992523
Name:CENTRAL VIRGINIA FAMILY PHYSICIANS, INC. LABORATORY
Entity Type:Organization
Organization Name:CENTRAL VIRGINIA FAMILY PHYSICIANS, INC. LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-382-1139
Mailing Address - Street 1:1111 CORPORATE PARK DR
Mailing Address - Street 2:STE C
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2286
Mailing Address - Country:US
Mailing Address - Phone:434-846-7708
Mailing Address - Fax:434-846-7713
Practice Address - Street 1:2019 TATE SPRINGS RD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1111
Practice Address - Country:US
Practice Address - Phone:434-846-7708
Practice Address - Fax:434-846-7713
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA FAMILY PHYSICIANS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-02
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA49D0914434291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA291U00000XOtherTAXONOMY