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NPI Code Detail

MEDICARE: UPPER MATTAPONI INDIAN TRIBE

MEDICARE: UPPER MATTAPONI INDIAN TRIBE
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
1333600000XPharmacy

General Provider Information

NPI Number : 1447838750
Entity Type Code : Organization
Provider Name (Legal Business Name) : UPPER MATTAPONI INDIAN TRIBE
Provider Business Mailing Address
First Line : 13476 KING WILLIAM RD
Second Line :
City : KING WILLIAM
State : VA
Zip : 23086-3401
Country : US
Telephone Number : 804-769-0041
Fax Number :
Provider Business Practice Location Address
First Line : 7864 RICHMOND TAPPAHANNOCK HWY
Second Line :
City : AYLETT
State : VA
Zip : 23009-3056
Country : US
Telephone Number : 804-769-2015
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : STEVE TUPPONCE
Credential :
Telephone Number : 804-347-4109
Provider Enumeration Date : 03/30/2021
Last Update Date : 11/17/2023

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Directions to “UPPER MATTAPONI INDIAN TRIBE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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