Provider Demographics
NPI:1962483131
Name:ABINGDON PHYSICIAN PARTNERS
Entity Type:Organization
Organization Name:ABINGDON PHYSICIAN PARTNERS
Other - Org Name:ABINGDON SURGICAL ASSOCIATS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFP
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-258-1777
Mailing Address - Street 1:16000 JOHNSTON MEMORIAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-7664
Mailing Address - Country:US
Mailing Address - Phone:276-258-1777
Mailing Address - Fax:276-258-1778
Practice Address - Street 1:16000 JOHNSTON MEMORIAL DR STE 101
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7664
Practice Address - Country:US
Practice Address - Phone:276-258-1777
Practice Address - Fax:276-258-1778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABINGDON PHYSICIAN PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-07
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5562OtherRAILROAD MEDICARE NUMBER
CA5562OtherRAILROAD MEDICARE NUMBER
C03026Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER