Healthcare Provider Details

I. General information

NPI: 1356432207
Provider Name (Legal Business Name): VIRGINIA MEDICAL ACUTE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 BACKLICK RD SUITE 105
SPRINGFIELD VA
22151-3933
US

IV. Provider business mailing address

5501 BACKLICK RD SUITE 105
SPRINGFIELD VA
22151-3933
US

V. Phone/Fax

Practice location:
  • Phone: 703-642-2273
  • Fax: 703-564-6544
Mailing address:
  • Phone: 703-642-2273
  • Fax: 703-564-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number0101027333
License Number StateVA

VIII. Authorized Official

Name: MRS. CAROLYN J GRANDERSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 703-642-2273