Healthcare Provider Details

I. General information

NPI: 1598020679
Provider Name (Legal Business Name): EMERGENCY PHYSICIANS IMMEDIATE CARE CENTER 1 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 02/11/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 HARBOURSIDE CENTER LOOP
MIDLOTHIAN VA
23112-2170
US

IV. Provider business mailing address

6100 HARBOURSIDE CENTER LOOP
MIDLOTHIAN VA
23112-2170
US

V. Phone/Fax

Practice location:
  • Phone: 804-639-7555
  • Fax: 804-739-4343
Mailing address:
  • Phone: 804-639-7555
  • Fax: 804-739-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TINA JEANNETTE LESTER
Title or Position: BILLING DIRECTOR
Credential:
Phone: 804-377-9111