Healthcare Provider Details

I. General information

NPI: 1932354222
Provider Name (Legal Business Name): SANDY RIVER FAMILY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 MEDICAL CENTER RD
AXTON VA
24054-2822
US

IV. Provider business mailing address

309 S MAIN ST
DANVILLE VA
24541-2925
US

V. Phone/Fax

Practice location:
  • Phone: 434-685-7095
  • Fax: 434-797-1300
Mailing address:
  • Phone: 434-797-4150
  • Fax: 434-797-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101053147
License Number StateVA

VIII. Authorized Official

Name: RAJENDRA S TRIVEDI
Title or Position: PRESIDENT
Credential: MD
Phone: 434-685-7095