Healthcare Provider Details

I. General information

NPI: 1679800619
Provider Name (Legal Business Name): VIRGINIA INTERNAL MEDICINE, PC AND URGENT CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6715 LITTLE RIVER TPKE SUITE 205
ANNANDALE VA
22003-3546
US

IV. Provider business mailing address

6715 LITTLE RIVER TPKE SUITE 205
ANNANDALE VA
22003-3546
US

V. Phone/Fax

Practice location:
  • Phone: 703-942-7339
  • Fax: 703-942-7448
Mailing address:
  • Phone: 703-942-7339
  • Fax: 703-942-7448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number0101245529
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number0101245529
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number0101245529
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0101245529
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number0101245529
License Number StateVA

VIII. Authorized Official

Name: DR. NANA O AMOAH
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 703-942-7339