Healthcare Provider Details

I. General information

NPI: 1972545531
Provider Name (Legal Business Name): EPMG OF VIRGINIA P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 S MAIN ST
BLACKSBURG VA
24060-7017
US

IV. Provider business mailing address

2000 GREEN RD SUITE 300
ANN ARBOR MI
48105-1598
US

V. Phone/Fax

Practice location:
  • Phone: 469-401-2386
  • Fax:
Mailing address:
  • Phone: 469-401-2386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN VINEYARD
Title or Position: OFFICER
Credential:
Phone: 469-401-2386