Healthcare Provider Details

I. General information

NPI: 1497017909
Provider Name (Legal Business Name): PLANNED PARENTHOOD HEALTH SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2964 HYDRAULIC RD
CHARLOTTESVILLE VA
22901-8902
US

IV. Provider business mailing address

100 S BOYLAN AVE
RALEIGH NC
27603-1802
US

V. Phone/Fax

Practice location:
  • Phone: 434-296-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number0201002791
License Number StateVA

VIII. Authorized Official

Name: STEVEN MAYNE
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 919-833-7534