Healthcare Provider Details

I. General information

NPI: 1376510644
Provider Name (Legal Business Name): MEMORIAL FAMILY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2006
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 RISON ST SUITE 120
DANVILLE VA
24541-2425
US

IV. Provider business mailing address

PO BOX 10399
DANVILLE VA
24543-5007
US

V. Phone/Fax

Practice location:
  • Phone: 434-792-3730
  • Fax: 434-792-6048
Mailing address:
  • Phone: 434-792-3730
  • Fax: 434-792-6048

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: MS. TAMARA R NEAL
Title or Position: BILLING MANAGER
Credential:
Phone: 434-792-3730