Provider Demographics
NPI:1669610986
Name:CENTRAL VIRGINIA FAMILY PHYSICIANS, INC
Entity type:Organization
Organization Name:CENTRAL VIRGINIA FAMILY PHYSICIANS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:HUTCHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-382-1125
Mailing Address - Street 1:1111 CORPORATE PARK DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2286
Mailing Address - Country:US
Mailing Address - Phone:434-382-1139
Mailing Address - Fax:434-525-5748
Practice Address - Street 1:14005 WARDS RD
Practice Address - Street 2:#A
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-7127
Practice Address - Country:US
Practice Address - Phone:434-239-0132
Practice Address - Fax:434-239-0490
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA FAMILY PHYSICIANS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-23
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC03658Medicare PIN