=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316919582
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTERNAL MEDICINE AND ENDOCRINOLOGY OF CENTRAL VIRGINIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 THOMSON DRIVE LOWER LEVEL
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501-1008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-947-5959
-----------------------------------------------------
Fax | 434-924-1293
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1901 THOMSON DRIVE LOWER LEVEL
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501-1008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-947-5959
-----------------------------------------------------
Fax | 434-924-1293
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SHAWN MICHAEL HAYES
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 434-947-5959
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 0101057596
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------