Provider Demographics
NPI:1679800619
Name:VIRGINIA INTERNAL MEDICINE, PC AND URGENT CARE SERVICES, INC.
Entity Type:Organization
Organization Name:VIRGINIA INTERNAL MEDICINE, PC AND URGENT CARE SERVICES, INC.
Other - Org Name:NANA OSEI AMOAH, MD: VIRGINIA INTERNAL MEDICINE, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NANA
Authorized Official - Middle Name:O
Authorized Official - Last Name:AMOAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-942-7339
Mailing Address - Street 1:6715 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3546
Mailing Address - Country:US
Mailing Address - Phone:703-942-7339
Mailing Address - Fax:703-942-7448
Practice Address - Street 1:6715 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 205
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3546
Practice Address - Country:US
Practice Address - Phone:703-942-7339
Practice Address - Fax:703-942-7448
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA INTERNAL MEDICINE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-12
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101245529261QP2300X, 261QU0200X, 281P00000X, 282E00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No281P00000XHospitalsChronic Disease Hospital
No282E00000XHospitalsLong Term Care Hospital
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1962646596Medicaid
VA1962646596Medicaid