Provider Demographics
NPI:1316359292
Name:BLUEPOINT MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:BLUEPOINT MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATAUNYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-385-8222
Mailing Address - Street 1:14631 LEE HIGHWAY
Mailing Address - Street 2:SUITE 413
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-5824
Mailing Address - Country:US
Mailing Address - Phone:703-385-8222
Mailing Address - Fax:703-832-8809
Practice Address - Street 1:14631 LEE HIGHWAY
Practice Address - Street 2:SUITE 413
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-5824
Practice Address - Country:US
Practice Address - Phone:703-385-8222
Practice Address - Fax:703-385-0882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA174400000X, 174400000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC89294Medicare UPIN