Provider Demographics
NPI:1508185810
Name:MEADOWBROOK MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:MEADOWBROOK MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ASHWORTH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:804-794-2443
Mailing Address - Street 1:PO BOX 74056
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-0001
Mailing Address - Country:US
Mailing Address - Phone:804-794-2443
Mailing Address - Fax:804-745-3800
Practice Address - Street 1:7410 HULL STREET RD
Practice Address - Street 2:SUITE 3
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-5834
Practice Address - Country:US
Practice Address - Phone:804-794-2443
Practice Address - Fax:804-745-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029898261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB09485Medicare UPIN
VAVAA103504Medicare PIN