Provider Demographics
NPI:1326099219
Name:TANGLEWOOD FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:TANGLEWOOD FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P VP S T
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:434-636-6903
Mailing Address - Street 1:9782 HWY 903
Mailing Address - Street 2:
Mailing Address - City:BRACEY
Mailing Address - State:VA
Mailing Address - Zip Code:23919-1991
Mailing Address - Country:US
Mailing Address - Phone:434-636-6903
Mailing Address - Fax:434-636-3826
Practice Address - Street 1:9782 HWY 903
Practice Address - Street 2:
Practice Address - City:BRACEY
Practice Address - State:VA
Practice Address - Zip Code:23919-1991
Practice Address - Country:US
Practice Address - Phone:434-636-6903
Practice Address - Fax:434-636-3826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CL0333OtherMEDICARE RAILROAD GROUP NUMBER
CL0333OtherMEDICARE RAILROAD GROUP NUMBER
VAC03393Medicare PIN