Provider Demographics
NPI:1376548461
Name:TAZEWELL FAMILY PHYSICANS, PC
Entity Type:Organization
Organization Name:TAZEWELL FAMILY PHYSICANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-988-2526
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-0645
Mailing Address - Country:US
Mailing Address - Phone:276-988-2526
Mailing Address - Fax:276-988-0956
Practice Address - Street 1:123 BEN BOLT AVE
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-9700
Practice Address - Country:US
Practice Address - Phone:276-988-2526
Practice Address - Fax:276-988-0956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030214261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care