Healthcare Provider Details

I. General information

NPI: 1649406679
Provider Name (Legal Business Name): COUNTRY CONTRACTORS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7683 RICHMOND RD.
TOANO VA
23168
US

IV. Provider business mailing address

PO BOX 550
TOANO VA
23168-0550
US

V. Phone/Fax

Practice location:
  • Phone: 757-566-8474
  • Fax: 757-566-8711
Mailing address:
  • Phone: 757-566-8474
  • Fax: 757-566-8711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number2701019832A
License Number StateVA

VIII. Authorized Official

Name: MR. DAVID R. TUFTEE
Title or Position: PRESIDENT
Credential:
Phone: 757-566-8474