Provider Demographics
NPI:1609816164
Name:FAMILY PRACTICE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:PORTER
Authorized Official - Last Name:BIDWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:757-562-2158
Mailing Address - Street 1:102 FAIRVIEW DR.
Mailing Address - Street 2:SUITE B
Mailing Address - City:FRANKILN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-1206
Mailing Address - Country:US
Mailing Address - Phone:757-562-2158
Mailing Address - Fax:757-562-2134
Practice Address - Street 1:102 FAIRVIEW DR.
Practice Address - Street 2:SUITE B
Practice Address - City:FRANKILN
Practice Address - State:VA
Practice Address - Zip Code:23851-1206
Practice Address - Country:US
Practice Address - Phone:757-562-2158
Practice Address - Fax:757-562-2134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101022437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty