MEDICARE: COLLABORATIVE ARTHRITIS CARE, INC

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	207RR0500X	Rheumatology Physician	0101238458	VA

General Provider Information

NPI Number	:	1477804680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLABORATIVE ARTHRITIS CARE, INC

Provider Business Mailing Address
First Line	:	300A TEMPLE LAKE DR STE 1
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2972
Country	:	US
Telephone Number	:	804-524-2400
Fax Number	:	804-526-1852

Provider Business Practice Location Address
First Line	:	300A TEMPLE LAKE DR STE 1
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2972
Country	:	US
Telephone Number	:	804-524-2400
Fax Number	:	804-526-1852

Authorized Official
Title or Position	:	ADMINISTRATIVE SERVICES MANAGER
Name	:	DEE DEE ALVIS
Credential	:
Telephone Number	:	804-518-1317

Provider Enumeration Date	:	09/27/2012
Last Update Date	:	09/27/2012

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