Provider Demographics
NPI:1346356813
Name:RAPPAHANNOCK FAMILY HEALTHCARE, INC
Entity Type:Organization
Organization Name:RAPPAHANNOCK FAMILY HEALTHCARE, INC
Other - Org Name:RAPPAHANNOCK FAMILY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-374-5097
Mailing Address - Street 1:120 EXECUTIVE CENTER PKWY STE 215
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3100
Mailing Address - Country:US
Mailing Address - Phone:540-374-5200
Mailing Address - Fax:540-374-0378
Practice Address - Street 1:120 EXECUTIVE CENTER PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3100
Practice Address - Country:US
Practice Address - Phone:540-374-5200
Practice Address - Fax:540-373-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102036807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5660599Medicaid
VAC02041Medicare ID - Type Unspecified
VA5660599Medicaid
VAC02500Medicare PIN
VAC05842Medicare PIN
VAC05759Medicare PIN
VAC36567Medicare UPIN
VAC06629Medicare PIN