Healthcare Provider Details

I. General information

NPI: 1770508442
Provider Name (Legal Business Name): MCV ASSOCIATED PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL STREET ANESTHESIOLOGY C03042
RICHMOND VA
23298-0510
US

IV. Provider business mailing address

1250 E MARSHALL STREET ANESTHESIOLOGY C03042
RICHMOND VA
23298-0510
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-8707
  • Fax: 807-828-8765
Mailing address:
  • Phone: 804-828-8707
  • Fax: 807-828-8765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MRS. EVELYN C HOUCHENS
Title or Position: DIRECTOR MEDICAL STAFF SERVICES
Credential: CPMSM CPCS
Phone: 804-828-8707