Provider Demographics
NPI:1417980343
Name:WICKHAM TITUS HENDRIX AND TURNER PTRS
Entity Type:Organization
Organization Name:WICKHAM TITUS HENDRIX AND TURNER PTRS
Other - Org Name:DRS TITUS HENDRIX TURNER PAHLE AND CHRISTENSEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:LINN
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-359-1351
Mailing Address - Street 1:2201 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4438
Mailing Address - Country:US
Mailing Address - Phone:804-359-1351
Mailing Address - Fax:804-355-6625
Practice Address - Street 1:2201 GROVE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4438
Practice Address - Country:US
Practice Address - Phone:804-359-1351
Practice Address - Fax:804-355-6625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049091207Q00000X
VA0101020690207R00000X
VA0101047848207R00000X
VA0101051667207R00000X
VA0101056275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C00010Medicare PIN