Provider Demographics
NPI:1093998148
Name:VIRGINIA PHYSICIANS, INC.
Entity Type:Organization
Organization Name:VIRGINIA PHYSICIANS, INC.
Other - Org Name:INNSBROOK PRIMARY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-545-9519
Mailing Address - Street 1:4900 COX RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6295
Mailing Address - Country:US
Mailing Address - Phone:804-346-1780
Mailing Address - Fax:804-346-1781
Practice Address - Street 1:4900 COX RD
Practice Address - Street 2:SUITE 150
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6295
Practice Address - Country:US
Practice Address - Phone:804-346-1780
Practice Address - Fax:804-346-1781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA PHYSICIANS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-12
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C10424Medicare PIN