Provider Demographics
NPI:1225282569
Name:EVMS ACADEMIC PHYSICIANS AND SURGEONS HEALTH SERVICES FOUNDATION
Entity Type:Organization
Organization Name:EVMS ACADEMIC PHYSICIANS AND SURGEONS HEALTH SERVICES FOUNDATION
Other - Org Name:EVMS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:LIND
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:757-451-6200
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-451-6200
Mailing Address - Fax:757-451-6251
Practice Address - Street 1:5900 LAKE WRIGHT DR STE B
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-1871
Practice Address - Country:US
Practice Address - Phone:757-213-5770
Practice Address - Fax:757-627-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty