=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225040587
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICAL FACILITIES OF AMERICA IV & IX PARTNERSHIP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2006
-----------------------------------------------------
Last Update Date | 05/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5615 SEMINOLE AVE
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24502-2201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-239-2657
-----------------------------------------------------
Fax | 434-239-4062
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2917 PENN FOREST BLVD
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24018-4374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-989-3618
-----------------------------------------------------
Fax | 540-774-9443
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO, MFA, INC. GENERAL PARTNER
-----------------------------------------------------
Name | MR. CLAUDE NOVEL MARTIN III
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 540-776-7526
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | NH2526
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------