Provider Demographics
NPI:1801319587
Name:VIRGINIA CANCER INSTITUTE INCORPORATED
Entity type:Organization
Organization Name:VIRGINIA CANCER INSTITUTE INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TABATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-391-4171
Mailing Address - Street 1:7202 GLEN FOREST DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3780
Mailing Address - Country:US
Mailing Address - Phone:804-391-4171
Mailing Address - Fax:804-200-6229
Practice Address - Street 1:6605 W BROAD ST STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1714
Practice Address - Country:US
Practice Address - Phone:804-287-3000
Practice Address - Fax:804-673-2731
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA CANCER INSTITUTE INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-25
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory