Healthcare Provider Details

I. General information

NPI: 1972975175
Provider Name (Legal Business Name): COLLABORATIVE HEALTH PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 CORPORATE PARK DR STE D
FOREST VA
24551-2279
US

IV. Provider business mailing address

1111 CORPORATE PARK DR STE D
FOREST VA
24551-2279
US

V. Phone/Fax

Practice location:
  • Phone: 434-382-1125
  • Fax: 434-525-6738
Mailing address:
  • Phone: 434-382-1125
  • Fax: 434-525-6738

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: THOMAS W EPPES
Title or Position: PRESIDENT
Credential: MD
Phone: 434-382-1125