Provider Demographics
NPI: | 1245709088 |
---|---|
Name: | ACCESS HEALTHCARE MULTI-SPECIALTY GROUP, PLLC |
Entity type: | Organization |
Organization Name: | ACCESS HEALTHCARE MULTI-SPECIALTY GROUP, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANDREW |
Authorized Official - Middle Name: | WILLIAM |
Authorized Official - Last Name: | PIELECK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DO |
Authorized Official - Phone: | 434-316-7199 |
Mailing Address - Street 1: | 2103 GRAVES MILL RD |
Mailing Address - Street 2: | |
Mailing Address - City: | FOREST |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 24551-2675 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 434-316-7199 |
Mailing Address - Fax: | 434-316-6185 |
Practice Address - Street 1: | 2103 GRAVES MILL RD |
Practice Address - Street 2: | |
Practice Address - City: | FOREST |
Practice Address - State: | VA |
Practice Address - Zip Code: | 24551-2675 |
Practice Address - Country: | US |
Practice Address - Phone: | 434-316-7199 |
Practice Address - Fax: | 434-316-6185 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-11-23 |
Last Update Date: | 2018-11-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207QS0010X | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | Group - Multi-Specialty |