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General NPI Number Information
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NPI Number | 1770768731
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Entity Type | Organization
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Legal Business Name | SUCTECK, INC
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 07/14/2009
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Provider Practice Location Address
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Address Line | 640 WARRIOR DR SUITE 109
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City | STEPHENS CITY
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State | VA
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Zip | 22655-4076
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Country | US
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Telephone | 540-868-2511
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Fax | 540-868-9105
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Provider Business Mailing Address
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Address Line | 640 WARRIOR DR SUITE 109
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City | STEPHENS CITY
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State | VA
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Zip | 22655-4076
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Country | US
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Telephone | 540-868-2511
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Fax | 540-868-9105
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | CHARLES A MIDDELHOF
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Credential | MD
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Telephone | 540-868-2511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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