Provider Demographics
NPI:1356646814
Name:VIRGINIA FAMILY PRACTICE PC
Entity Type:Organization
Organization Name:VIRGINIA FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIEDT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:804-784-4098
Mailing Address - Street 1:15078 BROWN PLEASANTS RD
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VA
Mailing Address - Zip Code:23192-2642
Mailing Address - Country:US
Mailing Address - Phone:804-883-0046
Mailing Address - Fax:804-883-0048
Practice Address - Street 1:15078 BROWN PLEASANTS RD
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VA
Practice Address - Zip Code:23192-2642
Practice Address - Country:US
Practice Address - Phone:804-883-0046
Practice Address - Fax:804-883-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9802Medicare PIN