Healthcare Provider Details

I. General information

NPI: 1811914872
Provider Name (Legal Business Name): JAMES RIVER FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12420 WARWICK BLVD 7B
NEWPORT NEWS VA
23606-3001
US

IV. Provider business mailing address

12420 WARWICK BLVD 7B
NEWPORT NEWS VA
23606-3001
US

V. Phone/Fax

Practice location:
  • Phone: 757-599-5588
  • Fax: 757-599-6893
Mailing address:
  • Phone: 757-599-5588
  • Fax: 757-599-6893

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: JAMES MATTHEW HALVERSON
Title or Position: OWNER
Credential: DO
Phone: 757-599-5588