Provider Demographics
NPI:1144239039
Name:CHILD ADOLESCENT HEALTH ASSOCIATES OF THE NEW RIVER VALLEY PC
Entity Type:Organization
Organization Name:CHILD ADOLESCENT HEALTH ASSOCIATES OF THE NEW RIVER VALLEY PC
Other - Org Name:NEW RIVER VALLEY PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEE
Authorized Official - Middle Name:W
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-639-5188
Mailing Address - Street 1:200 8TH ST
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-2426
Mailing Address - Country:US
Mailing Address - Phone:540-639-5188
Mailing Address - Fax:540-639-9215
Practice Address - Street 1:200 8TH ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-2426
Practice Address - Country:US
Practice Address - Phone:540-639-5188
Practice Address - Fax:540-639-9215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty