Provider Demographics
NPI:1144378704
Name:PATIENT FIRST
Entity Type:Organization
Organization Name:PATIENT FIRST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMS
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PHELAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-547-0688
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:STE 100
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:706 N BATTLEFIELD BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320
Practice Address - Country:US
Practice Address - Phone:757-547-0688
Practice Address - Fax:757-547-2902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
4835267OtherOTHER ID NUMBER-COMMERCIAL NUMBER
VANAMedicaid