Healthcare Provider Details

I. General information

NPI: 1104840701
Provider Name (Legal Business Name): UROLOGY ASSOC OF RICHMOND. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 JOHNSTON WILLIS DR SUITE 4500
N. CHESTERFIELD VA
23235-4730
US

IV. Provider business mailing address

1401 JOHNSTON WILLIS DR SUITE 4500
N CHESTERFIELD VA
23235-4730
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-1355
  • Fax: 804-320-2786
Mailing address:
  • Phone: 804-320-1355
  • Fax: 804-320-2786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101037753
License Number StateVA

VIII. Authorized Official

Name: MRS. PATRICIA DANIELLE HEATH
Title or Position: BILLING MANAGER
Credential:
Phone: 804-320-1355