Provider Demographics
NPI:1861820904
Name:MED SPA OF VIRGINIA, INC.
Entity Type:Organization
Organization Name:MED SPA OF VIRGINIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-825-8550
Mailing Address - Street 1:541 SUNSET LN
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3979
Mailing Address - Country:US
Mailing Address - Phone:540-825-8550
Mailing Address - Fax:540-825-8575
Practice Address - Street 1:541 SUNSET LN
Practice Address - Street 2:SUITE 302
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3979
Practice Address - Country:US
Practice Address - Phone:540-825-8550
Practice Address - Fax:540-825-8575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033835202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1316953839Medicaid
VA160001770Medicare UPIN
VAB59889Medicare UPIN