Provider Demographics
NPI:1578668430
Name:POWHATAN FAMILY PHYSICIANS, LTD
Entity Type:Organization
Organization Name:POWHATAN FAMILY PHYSICIANS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-794-1555
Mailing Address - Street 1:2615 ANDERSON HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-7400
Mailing Address - Country:US
Mailing Address - Phone:804-794-1555
Mailing Address - Fax:804-403-0334
Practice Address - Street 1:2615 ANDERSON HWY
Practice Address - Street 2:SUITE A
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-7400
Practice Address - Country:US
Practice Address - Phone:804-794-1555
Practice Address - Fax:804-403-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA550498OtherAETNA
VA050629OtherANTHEM
VA821002OtherMDIPA
VAC18289OtherMEDICARE RAILROAD
VA821002OtherMDIPA