Provider Demographics
NPI:1740328756
Name:FAMILY MEDICAL CENTER PC
Entity type:Organization
Organization Name:FAMILY MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-762-9646
Mailing Address - Street 1:2105 E PARHAM RD STE 109
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2236
Mailing Address - Country:US
Mailing Address - Phone:804-762-9646
Mailing Address - Fax:804-762-4754
Practice Address - Street 1:2105 E PARHAM RD STE 109
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2236
Practice Address - Country:US
Practice Address - Phone:804-762-9646
Practice Address - Fax:804-762-4754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B07645Medicare UPIN
080001265Medicare ID - Type Unspecified