Healthcare Provider Details

I. General information

NPI: 1609169408
Provider Name (Legal Business Name): RICHMOND CITY HEALTH DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 EASY CARY STREET
RICHMOND VA
23219
US

IV. Provider business mailing address

400 EASY CARY STREET
RICHMOND VA
23219
US

V. Phone/Fax

Practice location:
  • Phone: 804-205-5500
  • Fax:
Mailing address:
  • Phone: 804-205-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number0017139431
License Number StateVA

VIII. Authorized Official

Name: DR. SULOLA ADEKOYA
Title or Position: LEAD PHYSICIAN
Credential: MD
Phone: 804-482-5487