Provider Demographics
NPI:1679674113
Name:VIRGINIA PHYSICIAN INC
Entity Type:Organization
Organization Name:VIRGINIA PHYSICIAN INC
Other - Org Name:ASHLAND MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:W
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-798-8307
Mailing Address - Street 1:100 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-1125
Mailing Address - Country:US
Mailing Address - Phone:804-798-8307
Mailing Address - Fax:804-798-4204
Practice Address - Street 1:100 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-1125
Practice Address - Country:US
Practice Address - Phone:804-798-8307
Practice Address - Fax:804-798-4204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05733Medicare PIN