Healthcare Provider Details

I. General information

NPI: 1194040766
Provider Name (Legal Business Name): RICHMOND MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 PLANK RD
FREDERICKSBURG VA
22401-4951
US

IV. Provider business mailing address

3031 PLANK RD
FREDERICKSBURG VA
22401-4951
US

V. Phone/Fax

Practice location:
  • Phone: 540-736-5043
  • Fax: 540-736-5044
Mailing address:
  • Phone: 540-736-5043
  • Fax: 540-736-5044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number213000653
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARVIN WARREN BRIDGERS III
Title or Position: DIR. OF PHARMACY
Credential: RPH
Phone: 804-822-4383