Provider Demographics
NPI:1629035688
Name:CHRISTIANSBURG FAMILY PRACTICE,PC
Entity Type:Organization
Organization Name:CHRISTIANSBURG FAMILY PRACTICE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-382-6148
Mailing Address - Street 1:6 HICKOK ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-3524
Mailing Address - Country:US
Mailing Address - Phone:540-382-6148
Mailing Address - Fax:540-382-4191
Practice Address - Street 1:6 HICKOK ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-3524
Practice Address - Country:US
Practice Address - Phone:540-382-6148
Practice Address - Fax:540-382-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026426261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1733327OtherUNITED HEALTHCARE
VAC05193OtherMEDICARE
VAC05193OtherMEDICARE RAILROAD
VA4218482OtherAETNA PROVIDER NUMBER
VA76828OtherSOUTHERN HEALTH PROVIDER
VA237816OtherMAMSI PROVIDER NUMBER
VA1515558OtherUMWA PROVIDER NUMBER
VA263539OtherANTHEM
VA1515558OtherUMWA PROVIDER NUMBER
VA237816OtherMAMSI PROVIDER NUMBER
VA1733327OtherUNITED HEALTHCARE