Provider Demographics
NPI:1518376086
Name:EVMS ACADEMIC PHYSICIANS AND SURGEONS HEALTH SERVICES FOUNDATION
Entity Type:Organization
Organization Name:EVMS ACADEMIC PHYSICIANS AND SURGEONS HEALTH SERVICES FOUNDATION
Other - Org Name:EVMS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:LIND
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:757-451-6266
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:EVMS MEDICAL GROUP
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5629
Mailing Address - Fax:757-446-6000
Practice Address - Street 1:721 FAIRFAX AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-2007
Practice Address - Country:US
Practice Address - Phone:757-446-5629
Practice Address - Fax:757-446-6000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty