Provider Demographics
| NPI: | 1770517807 |
|---|---|
| Name: | MCV ASSOCIATED PHYSICIANS |
| Entity type: | Organization |
| Organization Name: | MCV ASSOCIATED PHYSICIANS |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR, MEDICAL STAFF SERVICES |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | EVELYN |
| Authorized Official - Middle Name: | C |
| Authorized Official - Last Name: | HOUCHENS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | CPMSM CPCS |
| Authorized Official - Phone: | 804-828-8707 |
| Mailing Address - Street 1: | 1250 E MARSHALL STREET |
| Mailing Address - Street 2: | PM&R C03697 |
| Mailing Address - City: | RICHMOND |
| Mailing Address - State: | VA |
| Mailing Address - Zip Code: | 23298-0510 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 804-828-8707 |
| Mailing Address - Fax: | 804-828-8765 |
| Practice Address - Street 1: | 1250 E MARSHALL STREET |
| Practice Address - Street 2: | MCV HOSPITALS VCU MEDICAL CENTER |
| Practice Address - City: | RICHMOND |
| Practice Address - State: | VA |
| Practice Address - Zip Code: | 23298-0510 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 804-828-8707 |
| Practice Address - Fax: | 804-828-8765 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | MCV ASSOCIATED PHYSICIANS |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-07-11 |
| Last Update Date: | 2008-05-20 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 2081P0004X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Spinal Cord Injury Medicine | Group - Multi-Specialty |
| No | 2081P0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pediatric Rehabilitation Medicine | Group - Multi-Specialty |
| No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Multi-Specialty |
| No | 2081S0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | Group - Multi-Specialty |
| No | 2083A0100X | Allopathic & Osteopathic Physicians | Preventive Medicine | Aerospace Medicine | Group - Multi-Specialty |
| No | 2083P0011X | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine | Group - Multi-Specialty |
| No | 2083P0500X | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine | Group - Multi-Specialty |
| No | 2083P0901X | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine | Group - Multi-Specialty |
| No | 2083T0002X | Allopathic & Osteopathic Physicians | Preventive Medicine | Medical Toxicology | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| VA | 5734371 | Medicaid | |
| VA | 5734371 | Medicaid |
