Healthcare Provider Details

I. General information

NPI: 1770660847
Provider Name (Legal Business Name): CENTRAL VIRGINIA FAMILY PHYSICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1088 LONDON LINKS DR
FOREST VA
24551-4662
US

IV. Provider business mailing address

PO BOX 2489
FOREST VA
24551-6489
US

V. Phone/Fax

Practice location:
  • Phone: 434-534-6868
  • Fax: 434-534-8808
Mailing address:
  • Phone: 434-382-1139
  • Fax: 434-525-5748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN L HAYNES
Title or Position: STAFF CREDENTIALING MANAGER
Credential:
Phone: 434-382-1139