Healthcare Provider Details

I. General information

NPI: 1720175953
Provider Name (Legal Business Name): CENTRAL VIRGINIA FAMILY PHYSICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 POCKET RD
HURT VA
24563-2023
US

IV. Provider business mailing address

PO BOX 2489
FOREST VA
24551-6489
US

V. Phone/Fax

Practice location:
  • Phone: 434-324-9150
  • Fax: 434-324-8248
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