Provider Demographics
NPI:1720175961
Name:CENTRAL VIRGINIA FAMILY PHYSICIANS, INC
Entity Type:Organization
Organization Name:CENTRAL VIRGINIA FAMILY PHYSICIANS, INC
Other - Org Name:TIMBERLAKE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-846-7374
Mailing Address - Street 1:PO BOX 2489
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-6489
Mailing Address - Country:US
Mailing Address - Phone:434-382-1125
Mailing Address - Fax:434-525-5748
Practice Address - Street 1:20304 TIMBERLAKE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-7222
Practice Address - Country:US
Practice Address - Phone:434-237-6471
Practice Address - Fax:434-237-8810
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA FAMILY PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-09
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1528155892OtherCVFP CORPORATE NPI
VACC2392OtherMEDICARE RAILROAD
VA1528155892Medicaid
VAC03658OtherCVFP MCARE GROUP PTAN
VA1528155892OtherCVFP CORPORATE NPI
VAC03658OtherCVFP MCARE GROUP PTAN