Provider Demographics
NPI:1740267277
Name:WHITE STONE FAMILY PRACTICE
Entity type:Organization
Organization Name:WHITE STONE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BUELL
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-435-3133
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:WHITE STONE
Mailing Address - State:VA
Mailing Address - Zip Code:22578-0046
Mailing Address - Country:US
Mailing Address - Phone:804-435-3133
Mailing Address - Fax:804-435-1311
Practice Address - Street 1:30 SHADY LANE
Practice Address - Street 2:
Practice Address - City:WHITE STONE
Practice Address - State:VA
Practice Address - Zip Code:22578-0046
Practice Address - Country:US
Practice Address - Phone:804-435-3133
Practice Address - Fax:804-435-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C03751Medicare PIN
C01882Medicare PIN