MEDICARE: OLYMPIA FAMILY MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101249977	VA

General Provider Information

NPI Number	:	1235546201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLYMPIA FAMILY MEDICINE

Provider Business Mailing Address
First Line	:	14024 WILEY CIR
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-5578
Country	:	US
Telephone Number	:	804-639-8145
Fax Number	:	804-818-2637

Provider Business Practice Location Address
First Line	:	14024 WILEY CIR
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-5578
Country	:	US
Telephone Number	:	804-639-8145
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. BERNICE NATALIE MUCUIS-PENHA
Credential	:	MD
Telephone Number	:	804-639-8145

Provider Enumeration Date	:	07/22/2014
Last Update Date	:	03/07/2023

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Directions to “OLYMPIA FAMILY MEDICINE ” Practice Location

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