Provider Demographics
NPI:1619176872
Name:JAMES RIVER PEDIATRICS PC
Entity Type:Organization
Organization Name:JAMES RIVER PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZACHARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-794-1072
Mailing Address - Street 1:1521 HUGUENOT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2474
Mailing Address - Country:US
Mailing Address - Phone:804-794-1072
Mailing Address - Fax:
Practice Address - Street 1:1521 HUGUENOT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2474
Practice Address - Country:US
Practice Address - Phone:804-794-1072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
818402OtherMAMSI GROUP
VA082365OtherBC/BS
VA1022006OtherCIGNA
285503OtherSOUTHERN HEALTH
VA818403OtherMAMSI
0753949OtherCIGNA
VA8114312OtherMAMSI
VA087261OtherBC/BS GROUP
VA289596OtherBC/BS
4511327OtherAETNA
VA677345OtherAETNA
747879OtherAETNA
VA7947576OtherAETNA
VA06797725Medicaid
76893OtherVA PREMIER
VA06797725Medicaid