Provider Demographics
NPI:1659578862
Name:BLACKSBURG FAMILY CARE LLC
Entity Type:Organization
Organization Name:BLACKSBURG FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-650-2907
Mailing Address - Street 1:708 N MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-3351
Mailing Address - Country:US
Mailing Address - Phone:540-951-9444
Mailing Address - Fax:
Practice Address - Street 1:708 N MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-3351
Practice Address - Country:US
Practice Address - Phone:540-951-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty