Provider Demographics
NPI:1427229574
Name:RATLIFF, MICHAEL A
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:RATLIFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 FRONT ST
Mailing Address - Street 2:SUITE 3050
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-2055
Mailing Address - Country:US
Mailing Address - Phone:276-963-8504
Mailing Address - Fax:276-963-6642
Practice Address - Street 1:2951 FRONT ST
Practice Address - Street 2:SUITE 3050
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2055
Practice Address - Country:US
Practice Address - Phone:276-963-8504
Practice Address - Fax:276-963-6642
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001142545163W00000X
TN17689367500000X
VA0024167652367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I434100Medicare PIN