Provider Demographics
NPI:1568897353
Name:LONGWOOD UNIVERSITY
Entity Type:Organization
Organization Name:LONGWOOD UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. AD OF SPORTS MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:MCTIGHE
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MED, ATC
Authorized Official - Phone:434-395-2965
Mailing Address - Street 1:201 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23909-1800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 HIGH ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23909-1800
Practice Address - Country:US
Practice Address - Phone:434-395-2965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization