Provider Demographics
NPI:1255851531
Name:BODEN HEALTH SYSTEM LLC
Entity Type:Organization
Organization Name:BODEN HEALTH SYSTEM LLC
Other - Org Name:VIRGINIA INTEGRATIVE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-508-0651
Mailing Address - Street 1:3038 VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2637
Mailing Address - Country:US
Mailing Address - Phone:540-508-0651
Mailing Address - Fax:540-585-4081
Practice Address - Street 1:3038 VALLEY AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2637
Practice Address - Country:US
Practice Address - Phone:540-508-0651
Practice Address - Fax:540-585-4081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty