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General NPI Number Information
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NPI Number | 1134450448
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Entity Type | Organization
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Legal Business Name | TRI-CITY MULTI-SPECIALTY, LLC
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Dates
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Enumeration Date | 01/26/2010
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Last Update Date | 09/07/2010
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Provider Practice Location Address
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Address Line | 906 CROSSINGS BLVD SUITE C
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City | HOPEWELL
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State | VA
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Zip | 23860-6503
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Country | US
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Telephone | 804-415-5000
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Fax | 804-415-5015
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Provider Business Mailing Address
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Address Line | 906 CROSSINGS BLVD SUITE C
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City | HOPEWELL
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State | VA
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Zip | 23860-6503
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Country | US
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Telephone | 804-415-5000
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Fax | 804-415-5015
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | WILLIAM TEDRICK JOHNSON
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Credential |
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Telephone | 804-237-7760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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