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General NPI Number Information
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NPI Number | 1568489086
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Entity Type | Organization
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Legal Business Name | MED ATLANTIC INC
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 03/22/2013
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Provider Practice Location Address
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Address Line | 8228 MEADOWBRIDGE RD
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-2331
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Country | US
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Telephone | 804-730-5023
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Fax |
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Provider Business Mailing Address
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Address Line | 9105 STONY POINT PKWY
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City | RICHMOND
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State | VA
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Zip | 23235-1979
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Country | US
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Telephone | 804-287-6100
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. TERRY COFFEY
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Credential |
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Telephone | 804-287-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | OH679
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License Number State | VA
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