Provider Demographics
NPI:1669829966
Name:BEACHGATE FAMILY MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:BEACHGATE FAMILY MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-761-7792
Mailing Address - Street 1:8546 GRAY FOX LN
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-3572
Mailing Address - Country:US
Mailing Address - Phone:804-761-7792
Mailing Address - Fax:
Practice Address - Street 1:700 MCKINNEY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COLONIAL BEACH
Practice Address - State:VA
Practice Address - Zip Code:22443-1933
Practice Address - Country:US
Practice Address - Phone:804-224-6322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care