Provider Demographics
NPI:1467654574
Name:COUNTRY DOCTOR, LTD
Entity Type:Organization
Organization Name:COUNTRY DOCTOR, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:CAMPAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-423-1788
Mailing Address - Street 1:35070 GERMANNA HEIGHTS DR
Mailing Address - Street 2:STE A
Mailing Address - City:LOCUST GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:22508-3108
Mailing Address - Country:US
Mailing Address - Phone:540-423-1788
Mailing Address - Fax:540-423-1755
Practice Address - Street 1:35070 GERMANNA HEIGHTS DR
Practice Address - Street 2:STE A
Practice Address - City:LOCUST GROVE
Practice Address - State:VA
Practice Address - Zip Code:22508-3108
Practice Address - Country:US
Practice Address - Phone:540-423-1788
Practice Address - Fax:540-423-1755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty