Provider Demographics
NPI:1275791105
Name:MCV ASSOCIATED PHYSICIANS
Entity Type:Organization
Organization Name:MCV ASSOCIATED PHYSICIANS
Other - Org Name:MCV PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR MEDICAL STAFF SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOUCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:CPMSM CPCS
Authorized Official - Phone:804-828-8707
Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL STREET
Practice Address - Street 2:DERMATOLOGY
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0510
Practice Address - Country:US
Practice Address - Phone:804-828-0300
Practice Address - Fax:804-828-9596
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCV ASSOCIATED PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5734371Medicaid
VAC03682Medicare PIN
VAC03684Medicare PIN