Provider Demographics
NPI:1639675507
Name:WHOLE HEALTH PHYSICIANS, PC
Entity Type:Organization
Organization Name:WHOLE HEALTH PHYSICIANS, PC
Other - Org Name:WHOLE HEALTH MD, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYDEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PASCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-601-4901
Mailing Address - Street 1:611 WATKINS CENTRE PARKWAY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114
Mailing Address - Country:US
Mailing Address - Phone:804-601-4901
Mailing Address - Fax:
Practice Address - Street 1:611 WATKINS CENTRE PKWY STE 350
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-4404
Practice Address - Country:US
Practice Address - Phone:804-601-4901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-01
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247582207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1578724274Medicaid