Healthcare Provider Details
I. General information
NPI: 1619176872
Provider Name (Legal Business Name): JAMES RIVER PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/17/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1521 HUGUENOT RD SUITE 101
MIDLOTHIAN VA
23113-2474
US
IV. Provider business mailing address
1521 HUGUENOT RD SUITE 101
MIDLOTHIAN VA
23113-2474
US
V. Phone/Fax
- Phone: 804-794-1072
- Fax:
- Phone: 804-794-1072
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2080A0000X |
| Taxonomy | Pediatric Adolescent Medicine Physician |
| License Number | |
| License Number State | |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 818402 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | MAMSI GROUP |
| # 2 | |
| Identifier | 082365 |
| Identifier Type | OTHER |
| Identifier State | VA |
| Identifier Issuer | BC/BS |
| # 3 | |
| Identifier | 1022006 |
| Identifier Type | OTHER |
| Identifier State | VA |
| Identifier Issuer | CIGNA |
| # 4 | |
| Identifier | 285503 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | SOUTHERN HEALTH |
| # 5 | |
| Identifier | 818403 |
| Identifier Type | OTHER |
| Identifier State | VA |
| Identifier Issuer | MAMSI |
| # 6 | |
| Identifier | 0753949 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CIGNA |
| # 7 | |
| Identifier | 8114312 |
| Identifier Type | OTHER |
| Identifier State | VA |
| Identifier Issuer | MAMSI |
| # 8 | |
| Identifier | 087261 |
| Identifier Type | OTHER |
| Identifier State | VA |
| Identifier Issuer | BC/BS GROUP |
| # 9 | |
| Identifier | 289596 |
| Identifier Type | OTHER |
| Identifier State | VA |
| Identifier Issuer | BC/BS |
| # 10 | |
| Identifier | 4511327 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | AETNA |
| # 11 | |
| Identifier | 677345 |
| Identifier Type | OTHER |
| Identifier State | VA |
| Identifier Issuer | AETNA |
| # 12 | |
| Identifier | 747879 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | AETNA |
| # 13 | |
| Identifier | 7947576 |
| Identifier Type | OTHER |
| Identifier State | VA |
| Identifier Issuer | AETNA |
| # 14 | |
| Identifier | 06797725 |
| Identifier Type | MEDICAID |
| Identifier State | VA |
| Identifier Issuer | |
| # 15 | |
| Identifier | 76893 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | VA PREMIER |
VIII. Authorized Official
Name: DR.
JOHN
ZACHARY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 804-794-1072
