Provider Demographics
NPI:1477823482
Name:DR AUGUSTINE MD & ASSOCIATES PRIMARY CARE MEDICAL CLINIC
Entity Type:Organization
Organization Name:DR AUGUSTINE MD & ASSOCIATES PRIMARY CARE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGUSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-271-5544
Mailing Address - Street 1:314 FAIRY STREET EXT
Mailing Address - Street 2:STE A
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1913
Mailing Address - Country:US
Mailing Address - Phone:757-271-5544
Mailing Address - Fax:757-271-6335
Practice Address - Street 1:314 FAIRY STREET EXT
Practice Address - Street 2:STE A
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1913
Practice Address - Country:US
Practice Address - Phone:757-271-5544
Practice Address - Fax:757-271-6335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101223331207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty