Provider Demographics
NPI:1508950056
Name:VIRGINIA PRIMARY CARE ASSOCIATES PC
Entity Type:Organization
Organization Name:VIRGINIA PRIMARY CARE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:SUANN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-633-5840
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:VA
Mailing Address - Zip Code:22427
Mailing Address - Country:US
Mailing Address - Phone:804-633-5840
Mailing Address - Fax:804-633-4438
Practice Address - Street 1:121 COURTHOUSE LANE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:VA
Practice Address - Zip Code:22427
Practice Address - Country:US
Practice Address - Phone:804-633-5840
Practice Address - Fax:804-633-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052515207Q00000X
VA0101034535207R00000X
VA0101237872207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7610351Medicaid
VAG18502Medicare UPIN
VAD71894Medicare UPIN
VA493834Medicare ID - Type Unspecified
VAI25098Medicare UPIN
VA008130V96Medicare ID - Type Unspecified