Healthcare Provider Details

I. General information

NPI: 1437379294
Provider Name (Legal Business Name): FAMILY PRACTICE SPECIALISTS OF RICHMOND, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3742 WINTERFIELD RD
MIDLOTHIAN VA
23113-9238
US

IV. Provider business mailing address

3742 WINTERFIELD RD
MIDLOTHIAN VA
23113-9238
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-3335
  • Fax: 804-320-2717
Mailing address:
  • Phone: 804-330-3335
  • Fax: 804-320-2717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CYNTHIA G SWIM
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 804-330-3335