Healthcare Provider Details

I. General information

NPI: 1134228935
Provider Name (Legal Business Name): VILLAGE FAMILY PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4830 RUCKER RD
MONETA VA
24121-5281
US

IV. Provider business mailing address

4830 RUCKER RD
MONETA VA
24121-5281
US

V. Phone/Fax

Practice location:
  • Phone: 540-297-7181
  • Fax: 540-297-6145
Mailing address:
  • Phone: 540-297-7181
  • Fax: 540-297-6145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JANICE E LUTH
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 540-297-7181