Healthcare Provider Details

I. General information

NPI: 1053322495
Provider Name (Legal Business Name): PATRICK COUNTY FAMILY PRACTICE,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18877 JEB STUART HIGHWAY
STUART VA
24171-1019
US

IV. Provider business mailing address

PO BOX 1019
STUART VA
24171-1019
US

V. Phone/Fax

Practice location:
  • Phone: 276-694-4466
  • Fax: 276-694-2909
Mailing address:
  • Phone: 276-694-4466
  • Fax: 276-694-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101 036915
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101 237621
License Number StateVA

VIII. Authorized Official

Name: RICHARD CLAUDE COLE
Title or Position: OWNER
Credential:
Phone: 276-694-4466