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General NPI Number Information
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NPI Number | 1508185810
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Entity Type | Organization
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Legal Business Name | MEADOWBROOK MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 05/26/2010
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Last Update Date | 01/13/2011
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Provider Practice Location Address
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Address Line | 7410 HULL STREET RD SUITE 3
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City | RICHMOND
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State | VA
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Zip | 23235-5834
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Country | US
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Telephone | 804-794-2443
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Fax | 804-745-3800
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Provider Business Mailing Address
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Address Line | PO BOX 74056
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City | RICHMOND
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State | VA
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Zip | 23236-0001
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Country | US
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Telephone | 804-794-2443
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Fax | 804-745-3800
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOEL THOMAS ASHWORTH JR.
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Credential | M.D.
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Telephone | 804-794-2443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0101029898
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License Number State | VA
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