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General NPI Number Information
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NPI Number | 1659529766
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Entity Type | Organization
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Legal Business Name | CROZET CHILDRENS HEALTH CENTER PC
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 5674 THREE NOTCHED RD
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City | CROZET
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State | VA
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Zip | 22932-3109
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Country | US
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Telephone | 434-823-5439
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Fax | 434-823-5453
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Provider Business Mailing Address
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Address Line | 5674 THREE NOTCHED RD
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City | CROZET
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State | VA
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Zip | 22932-3109
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Country | US
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Telephone | 434-823-5439
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Fax | 434-823-5453
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MARKETA KYNCL LEISURE
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Credential | MD
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Telephone | 434-823-5439
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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 | 0101044383
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License Number State | VA
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