Healthcare Provider Details

I. General information

NPI: 1043275977
Provider Name (Legal Business Name): VIRGINIA UROLOGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8152 PLEASANT GROVE RD
MECHANICSVILLE VA
23116-2343
US

IV. Provider business mailing address

9101 STONY POINT PKWY
RICHMOND VA
23235-2002
US

V. Phone/Fax

Practice location:
  • Phone: 804-730-5023
  • Fax:
Mailing address:
  • Phone: 804-287-1030
  • Fax: 804-288-3529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0419750002
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRIGETTE BOOTH
Title or Position: CEO
Credential:
Phone: 804-330-9105