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General NPI Number Information
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NPI Number | 1114741949
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Entity Type | Organization
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Legal Business Name | MIDLOMED LLC
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Dates
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Enumeration Date | 11/08/2024
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 5930 HARBOUR PARK DR
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-2169
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Country | US
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Telephone | 804-893-0337
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Fax | 689-202-0711
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Provider Business Mailing Address
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Address Line | 5930 HARBOUR PARK DR
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-2169
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Country | US
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Telephone | 804-893-0337
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Fax | 689-202-0711
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | GINA K SMOOT
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Credential | FNP
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Telephone | 804-375-1660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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