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General NPI Number Information
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NPI Number | 1669829966
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Entity Type | Organization
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Legal Business Name | BEACHGATE FAMILY MEDICAL CENTER LLC
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Dates
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Enumeration Date | 05/17/2016
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Last Update Date | 05/17/2016
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Provider Practice Location Address
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Address Line | 700 MCKINNEY BLVD STE 100
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City | COLONIAL BEACH
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State | VA
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Zip | 22443-1933
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Country | US
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Telephone | 804-224-6322
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Fax |
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Provider Business Mailing Address
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Address Line | 8546 GRAY FOX LN
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City | KING GEORGE
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State | VA
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Zip | 22485-3572
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Country | US
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Telephone | 804-761-7792
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MS. JESSICA HERRINK
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Credential |
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Telephone | 804-761-7792
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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 |
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License Number State |
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