Healthcare Provider Details

I. General information

NPI: 1780489823
Provider Name (Legal Business Name): FIRSTHAND HEALTH OF VIRGINIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 SANTA ROSA RD RM 109
RICHMOND VA
23229-5001
US

IV. Provider business mailing address

1032 E BRANDON BLVD STE 4567
BRANDON FL
33511-5509
US

V. Phone/Fax

Practice location:
  • Phone: 804-461-7008
  • Fax: 804-315-8560
Mailing address:
  • Phone: 201-474-5844
  • Fax: 855-737-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH PARKS
Title or Position: CHIEF MEDICAL DIRECTOR
Credential: MD
Phone: 573-864-8773