Healthcare Provider Details

I. General information

NPI: 1619246733
Provider Name (Legal Business Name): HEART SPECIALISTS OF RICHMOND, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W LEIGH ST SUITE 205
RICHMOND VA
23220-3200
US

IV. Provider business mailing address

505 W LEIGH ST SUITE 205
RICHMOND VA
23220-3200
US

V. Phone/Fax

Practice location:
  • Phone: 804-562-2769
  • Fax: 804-269-3406
Mailing address:
  • Phone: 804-562-2769
  • Fax: 804-269-3406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101034738
License Number StateVA

VIII. Authorized Official

Name: STEVEN F SHIELDS
Title or Position: BILLING MANAGER
Credential:
Phone: 804-282-9133