Healthcare Provider Details

I. General information

NPI: 1154868966
Provider Name (Legal Business Name): NAPA MEDICAL GROUP VIRGINIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10716 RICHMOND HWY
LORTON VA
22079-2644
US

IV. Provider business mailing address

61 COMMERCE AVE SW
GRAND RAPIDS MI
49503-4124
US

V. Phone/Fax

Practice location:
  • Phone: 703-997-0930
  • Fax: 703-997-0936
Mailing address:
  • Phone: 616-940-2662
  • Fax: 616-285-7220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA GRIMALDI
Title or Position: DIRECTOR OF ADMINISTRATIVE SERVICES
Credential:
Phone: 616-940-2662