Provider Demographics
NPI: | 1497282503 |
---|---|
Name: | DOMINION FAMILY CARE, LLC |
Entity Type: | Organization |
Organization Name: | DOMINION FAMILY CARE, LLC |
Other - Org Name: | AFC URGENT CARE GLEN ALLEN |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MEDICAL DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ANDREA |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | HALL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 804-747-5555 |
Mailing Address - Street 1: | 4101 DOMINION BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | GLEN ALLEN |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23060-3457 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 804-747-5555 |
Mailing Address - Fax: | 804-747-5550 |
Practice Address - Street 1: | 4101 DOMINION BLVD |
Practice Address - Street 2: | |
Practice Address - City: | GLEN ALLEN |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23060-3457 |
Practice Address - Country: | US |
Practice Address - Phone: | 804-747-5555 |
Practice Address - Fax: | 804-747-5550 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-05-19 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty |