Provider Demographics
NPI:1558575951
Name:B & B MEDICAL PC
Entity Type:Organization
Organization Name:B & B MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THONGDANG
Authorized Official - Middle Name:
Authorized Official - Last Name:BANCHUIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-679-0818
Mailing Address - Street 1:280 VA AVE NE
Mailing Address - Street 2:STE 102
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273
Mailing Address - Country:US
Mailing Address - Phone:276-679-0818
Mailing Address - Fax:276-679-9128
Practice Address - Street 1:280 VA AVE NE
Practice Address - Street 2:STE 102
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273
Practice Address - Country:US
Practice Address - Phone:276-679-0818
Practice Address - Fax:276-679-9128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029458208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06838Medicare PIN