Provider Demographics
NPI:1326228800
Name:PARTNERS IN FAMILY MEDICINE
Entity Type:Organization
Organization Name:PARTNERS IN FAMILY MEDICINE
Other - Org Name:PARTNERS IN FAMILY PRACTICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:SQUIRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-253-1130
Mailing Address - Street 1:430 CLAREMONT CT
Mailing Address - Street 2:SUITE 123
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1770
Mailing Address - Country:US
Mailing Address - Phone:804-526-1130
Mailing Address - Fax:804-526-0006
Practice Address - Street 1:430 CLAREMONT CT
Practice Address - Street 2:SUITE 123
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1770
Practice Address - Country:US
Practice Address - Phone:804-526-1130
Practice Address - Fax:804-526-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032046207Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1942295084Medicare PIN
VAGC1076Medicare PIN