Healthcare Provider Details

I. General information

NPI: 1386028793
Provider Name (Legal Business Name): CMH PHYSICIAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BUENA VISTA CIR
SOUTH HILL VA
23970-1431
US

IV. Provider business mailing address

PO BOX 623
SOUTH HILL VA
23970-0623
US

V. Phone/Fax

Practice location:
  • Phone: 434-447-3151
  • Fax: 434-774-2452
Mailing address:
  • Phone: 434-584-2273
  • Fax: 434-584-5543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: WARREN SCOTT BURNETTE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 434-584-2499