Provider Demographics
NPI:1710017108
Name:VIRGINIA CANCER INSITUTE WEST END
Entity Type:Organization
Organization Name:VIRGINIA CANCER INSITUTE WEST END
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALS
Authorized Official - Prefix:
Authorized Official - First Name:TABATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:804-391-4171
Mailing Address - Street 1:6605 W BROAD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1714
Mailing Address - Country:US
Mailing Address - Phone:804-287-3000
Mailing Address - Fax:804-282-3314
Practice Address - Street 1:6605 W BROAD ST
Practice Address - Street 2:SUITE A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1714
Practice Address - Country:US
Practice Address - Phone:804-287-3000
Practice Address - Fax:804-282-3314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010039943336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05844Medicare ID - Type UnspecifiedGROUP ID
VAC01120Medicare ID - Type UnspecifiedGROUP ID
VAC06534Medicare ID - Type UnspecifiedGROUP ID