Provider Demographics
NPI:1356432207
Name:VIRGINIA MEDICAL ACUTE CARE PC
Entity type:Organization
Organization Name:VIRGINIA MEDICAL ACUTE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-642-2273
Mailing Address - Street 1:5501 BACKLICK RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-3933
Mailing Address - Country:US
Mailing Address - Phone:703-642-2273
Mailing Address - Fax:703-564-6544
Practice Address - Street 1:5501 BACKLICK RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-3933
Practice Address - Country:US
Practice Address - Phone:703-642-2273
Practice Address - Fax:703-564-6544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027333261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1336247261OtherNPI # DR. MARK DAVIS
VAC88872Medicare UPIN