Provider Demographics
NPI:1750571287
Name:COMMONWEALTH PRIMARY CARE
Entity type:Organization
Organization Name:COMMONWEALTH PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-288-0399
Mailing Address - Street 1:1800 GLENSIDE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3769
Mailing Address - Country:US
Mailing Address - Phone:804-288-0399
Mailing Address - Fax:804-285-0088
Practice Address - Street 1:1800 GLENSIDE DR STE 105
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3769
Practice Address - Country:US
Practice Address - Phone:804-288-0399
Practice Address - Fax:804-285-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA141469OtherANTHEM
VA303278OtherANTHEM
VA304078OtherANTHEM
VACC6597OtherMEDICARE RAILROAD
VA141464OtherANTHEM
VA141466OtherANTHEM
VA141468OtherANTHEM
VACK5367OtherMEDICARE RAILROAD
VACJ7063OtherMEDICARE RAILROAD
VA1141467OtherANTHEM
VACL1914OtherMEDICARE RAILROAD
VA141465OtherANTHEM
VA292413OtherANTHEM
VA141469OtherANTHEM
VA292413OtherANTHEM
VA141464OtherANTHEM
VACK5367OtherMEDICARE RAILROAD
VAC08426Medicare PIN
VAC08113Medicare PIN
VAC08112Medicare PIN