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General NPI Number Information
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NPI Number | 1730304742
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Entity Type | Organization
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Legal Business Name | WELLSPRING FAMILY MEDICAL CENTER
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 648 INDEPENDENCE PKWY SUITE 300
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City | CHESAPEAKE
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State | VA
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Zip | 23320-5206
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Country | US
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Telephone | 757-312-0166
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Fax | 757-312-8116
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Provider Business Mailing Address
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Address Line | 648 INDEPENDENCE PKWY SUITE 300
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City | CHESAPEAKE
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State | VA
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Zip | 23320-5206
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Country | US
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Telephone | 757-312-0166
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Fax | 757-312-8116
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. NATHAN L RILES JR.
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Credential | M.D.
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Telephone | 757-312-0166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0101044787
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License Number State | VA
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