Provider Demographics
NPI:1811061013
Name:EMPORIA MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:EMPORIA MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-634-6101
Mailing Address - Street 1:6 DOCTORS DRIVE
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-1240
Mailing Address - Country:US
Mailing Address - Phone:434-634-6101
Mailing Address - Fax:434-634-7117
Practice Address - Street 1:6 DOCTORS DRIVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1240
Practice Address - Country:US
Practice Address - Phone:434-634-6101
Practice Address - Fax:434-634-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA187098OtherANTHEM BLUE SHIELD
VAC01182Medicare ID - Type Unspecified