Provider Demographics
NPI:1568875235
Name:C3 NEXUS LLC
Entity Type:Organization
Organization Name:C3 NEXUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-325-1122
Mailing Address - Street 1:737 N 5TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-1441
Mailing Address - Country:US
Mailing Address - Phone:804-325-1122
Mailing Address - Fax:
Practice Address - Street 1:737 N 5TH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-1441
Practice Address - Country:US
Practice Address - Phone:804-325-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045588261QR0404X, 364SC2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac FacilitiesGroup - Single Specialty
No364SC2300XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistChronic CareGroup - Single Specialty