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General NPI Number Information
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NPI Number | 1295879328
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Entity Type | Organization
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Legal Business Name | ARCHWAY 60 FAMILY PRACTICE
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/28/2007
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Provider Practice Location Address
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Address Line | 1600 HUGUENDT ROAD SUITE 121
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City | MIDLOTHIAN
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State | VA
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Zip | 23113
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Country | US
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Telephone | 804-378-9657
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Fax | 804-378-7858
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Provider Business Mailing Address
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Address Line | PO BOX 247
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City | MIDLOTHIAN
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State | VA
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Zip | 23113
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Country | US
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Telephone | 804-378-5010
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Fax | 804-378-3264
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DORIS A REID
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Credential | MD
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Telephone | 804-378-9657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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