Healthcare Provider Details

I. General information

NPI: 1215926332
Provider Name (Legal Business Name): RICHMOND PEDIATRIC SURGEONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7115 JAHNKE RD
RICHMOND VA
23225-4017
US

IV. Provider business mailing address

2000 HEALTH PARK DR
BRENTWOOD TN
37027-4525
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-6727
  • Fax: 804-228-6730
Mailing address:
  • Phone: 615-373-7600
  • Fax: 866-346-1426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM TEDRICK JOHNSON
Title or Position: GROUP VP/AO
Credential:
Phone: 615-372-3375