Healthcare Provider Details

I. General information

NPI: 1427129147
Provider Name (Legal Business Name): VIRGINIA MEDICAL GROUP SLEEP CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 TEMPLE AVE
COLONIAL HEIGHTS VA
23834-2827
US

IV. Provider business mailing address

213 TEMPLE AVE
COLONIAL HEIGHTS VA
23834-2827
US

V. Phone/Fax

Practice location:
  • Phone: 804-526-0682
  • Fax:
Mailing address:
  • Phone: 804-524-2260
  • Fax: 804-524-0096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT S. DAVIS
Title or Position: MBR
Credential: M.D.
Phone: 804-524-2260