Provider Demographics
NPI:1194040766
Name:RICHMOND MEDICAL GROUP
Entity Type:Organization
Organization Name:RICHMOND MEDICAL GROUP
Other - Org Name:PATIENT FIRST FREDERICKSBURG
Other - Org Type:Other Name
Authorized Official - Title/Position:DIR. OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:BRIDGERS
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:804-822-4383
Mailing Address - Street 1:3031 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4951
Mailing Address - Country:US
Mailing Address - Phone:540-736-5043
Mailing Address - Fax:540-736-5044
Practice Address - Street 1:3031 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4951
Practice Address - Country:US
Practice Address - Phone:540-736-5043
Practice Address - Fax:540-736-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QU0200X
VA213000653332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No332900000XSuppliersNon-Pharmacy Dispensing Site