Provider Demographics
NPI:1679628499
Name:DR. ZELDA WEST JOHNSON & ASSOCIATES
Entity Type:Organization
Organization Name:DR. ZELDA WEST JOHNSON & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZELDA
Authorized Official - Middle Name:WEST
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-644-5440
Mailing Address - Street 1:PO BOX 8001
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-0001
Mailing Address - Country:US
Mailing Address - Phone:804-644-5440
Mailing Address - Fax:804-497-3397
Practice Address - Street 1:101 COWARDIN AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-2078
Practice Address - Country:US
Practice Address - Phone:804-644-5440
Practice Address - Fax:804-497-3397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057120261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005602912Medicaid
VA005630070Medicaid
VAC09016Medicare PIN
VAG77165Medicare UPIN
VA005630070Medicaid