Provider Demographics
NPI:1659601250
Name:SPRY INSIDE FAMILY MEDICINE
Entity Type:Organization
Organization Name:SPRY INSIDE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRONWYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:804-288-1152
Mailing Address - Street 1:3004 QUAIL WALK DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5220
Mailing Address - Country:US
Mailing Address - Phone:804-920-0690
Mailing Address - Fax:804-288-5211
Practice Address - Street 1:2008 BREMO RD
Practice Address - Street 2:SUITE 111
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2443
Practice Address - Country:US
Practice Address - Phone:804-288-1152
Practice Address - Fax:804-288-5211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001914174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty