Provider Demographics
NPI:1528022506
Name:PETERSBURG CLINIC COMPANY, LLC
Entity Type:Organization
Organization Name:PETERSBURG CLINIC COMPANY, LLC
Other - Org Name:HEALTH CARE PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GROUP VP
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-647-5069
Mailing Address - Street 1:436 CLAREMONT CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1765
Mailing Address - Country:US
Mailing Address - Phone:804-526-2121
Mailing Address - Fax:804-520-2617
Practice Address - Street 1:436 CLAREMONT CT
Practice Address - Street 2:SUITE 100
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1765
Practice Address - Country:US
Practice Address - Phone:804-526-2121
Practice Address - Fax:804-520-2617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty