Healthcare Provider Details

I. General information

NPI: 1801319587
Provider Name (Legal Business Name): VIRGINIA CANCER INSTITUTE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6605 W BROAD ST STE A
RICHMOND VA
23230-1714
US

IV. Provider business mailing address

7202 GLEN FOREST DR STE 200
RICHMOND VA
23226-3780
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-3000
  • Fax: 804-673-2731
Mailing address:
  • Phone: 804-391-4171
  • Fax: 804-200-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: TABATHA FARMER
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 804-391-4171