Provider Demographics
NPI:1396968392
Name:CARY STREET FAMILY PRACTICE
Entity type:Organization
Organization Name:CARY STREET FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:BROOKS
Authorized Official - Last Name:DEATS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-353-0010
Mailing Address - Street 1:4906 CUTSHAW AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3630
Mailing Address - Country:US
Mailing Address - Phone:804-353-0010
Mailing Address - Fax:804-278-8796
Practice Address - Street 1:4906 CUTSHAW AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3630
Practice Address - Country:US
Practice Address - Phone:804-353-0010
Practice Address - Fax:804-278-8796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty