Provider Demographics
NPI:1467532218
Name:CENTREVILLE FAMILY PRACTICE
Entity Type:Organization
Organization Name:CENTREVILLE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BOXLEY
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-631-0331
Mailing Address - Street 1:13890 BRADDOCK RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2435
Mailing Address - Country:US
Mailing Address - Phone:703-631-0331
Mailing Address - Fax:703-631-2573
Practice Address - Street 1:13890 BRADDOCK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2435
Practice Address - Country:US
Practice Address - Phone:703-631-0331
Practice Address - Fax:703-631-2573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA84280003OtherCAREFIRST KEYES
VA015385OtherANTHEM BOWLES
VA054086OtherANTHEM KEYES
VA7118167002OtherCIGNA BOWLES
VA299284OtherAMERIGROUP KEYES
VA7526767001OtherCIGNA KEYES
VA84280002OtherCAREFIRST BOWLES
VA898399OtherAETNA BOWLES
VA0100537OtherUNITED HEALTH CARE
VA5674719Medicaid
VA299304OtherAMERIGROUP BOWLES
VA898405OtherAETNA KEYES
VAD05803Medicare UPIN
VA00476297Medicare ID - Type UnspecifiedDR. KEYES
VA00410125Medicare ID - Type UnspecifiedCENTREVILLE FAMILY PRACTI
VA7526767001OtherCIGNA KEYES
VA001817Medicare ID - Type UnspecifiedDR. BOWLES