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?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty