Provider Demographics
NPI:1942239868
Name:MEDIDOCTORS, LLC, D/B/A PSYCHIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:MEDIDOCTORS, LLC, D/B/A PSYCHIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP AMBULATORY SERVICES AND PROPERTY
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PREWITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-741-1428
Mailing Address - Street 1:12000 KENNEDY LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6016
Mailing Address - Country:US
Mailing Address - Phone:540-741-7100
Mailing Address - Fax:540-741-7103
Practice Address - Street 1:12000 KENNEDY LN
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6016
Practice Address - Country:US
Practice Address - Phone:540-741-7100
Practice Address - Fax:540-741-7103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002969103TC0700X
VA09040006221041C0700X
VA09040040301041C0700X
VA09040044601041C0700X
VA09040028761041C0700X
VA09040047091041C0700X
VA01012358112084P0800X
VA01012287652084P0800X
VA01010556452084P0800X
VA01012268772084P0800X
VA01012378662084P0800X
VA01012313182084P0800X
VA01012378002084P0800X
VA01012220792084P0800X
VA01012360772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty