Healthcare Provider Details

I. General information

NPI: 1013187947
Provider Name (Legal Business Name): KEMPSVILLE PRIMARY MEDICAL CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5136 PRINCESS ANNE RD
VIRGINIA BCH VA
23462-4228
US

IV. Provider business mailing address

5136 PRINCESS ANNE RD
VIRGINIA BCH VA
23462-4228
US

V. Phone/Fax

Practice location:
  • Phone: 757-473-0003
  • Fax: 757-497-9510
Mailing address:
  • Phone: 757-473-0003
  • Fax: 757-497-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number0101034998
License Number StateVA

VIII. Authorized Official

Name: DR. JOSUE APILAN MIRANDA
Title or Position: OWNER
Credential: MD
Phone: 757-473-0003