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General NPI Number Information
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NPI Number | 1366958274
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Entity Type | Organization
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Legal Business Name | CLINICAL COLLEAGUES INC
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Dates
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Enumeration Date | 12/15/2017
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 200 MEDICAL PARK BLVD
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City | PETERSBURG
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State | VA
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Zip | 23805-9274
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Country | US
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Telephone | 804-765-5000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 824246
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City | PHILADELPHIA
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State | PA
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Zip | 19182-4246
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Country | US
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Telephone | 954-570-0337
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | KURT ZUMWALT
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Credential |
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Telephone | 800-494-3948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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