Provider Demographics
NPI:1851576383
Name:CULPEPER SPECIALIST PHYSICIANS, LLC
Entity Type:Organization
Organization Name:CULPEPER SPECIALIST PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TREVA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-825-5595
Mailing Address - Street 1:14115 LOVERS LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-4157
Mailing Address - Country:US
Mailing Address - Phone:540-825-5595
Mailing Address - Fax:540-825-5272
Practice Address - Street 1:541 SUNSET LN
Practice Address - Street 2:SUITE 102
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3979
Practice Address - Country:US
Practice Address - Phone:540-829-8484
Practice Address - Fax:540-829-6699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C10542OtherMEDICARE GROUP PTAN
C10542OtherMEDICARE GROUP PTAN