Provider Demographics
NPI:1497870877
Name:FAMILY MEDICINE OF FARMVILLE, INC.
Entity Type:Organization
Organization Name:FAMILY MEDICINE OF FARMVILLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:T
Authorized Official - Last Name:VARNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:434-392-6101
Mailing Address - Street 1:400 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1524
Mailing Address - Country:US
Mailing Address - Phone:434-392-6101
Mailing Address - Fax:434-392-1003
Practice Address - Street 1:400 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1524
Practice Address - Country:US
Practice Address - Phone:434-392-6101
Practice Address - Fax:434-392-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035792174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5603242Medicaid
VAB07196Medicare UPIN