Provider Demographics
NPI:1669794921
Name:CENTRAL VIRGINIA FAMILY MEDICINE, P.C.
Entity type:Organization
Organization Name:CENTRAL VIRGINIA FAMILY MEDICINE, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITZI
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-370-4370
Mailing Address - Street 1:211 PARK HILL DR STE B
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3361
Mailing Address - Country:US
Mailing Address - Phone:540-370-4370
Mailing Address - Fax:540-370-4331
Practice Address - Street 1:211 PARK HILL DR STE B
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3361
Practice Address - Country:US
Practice Address - Phone:540-370-4370
Practice Address - Fax:540-370-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA080006928OtherMEDICARE PTAN
VA5609127Medicaid
VA5609127Medicaid