=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780489823
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRSTHAND HEALTH OF VIRGINIA PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2025
-----------------------------------------------------
Last Update Date | 02/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1606 SANTA ROSA RD RM 109
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23229-5001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-461-7008
-----------------------------------------------------
Fax | 804-315-8560
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1032 E BRANDON BLVD STE 4567
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33511-5509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-474-5844
-----------------------------------------------------
Fax | 855-737-3901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF MEDICAL DIRECTOR
-----------------------------------------------------
Name | JOSEPH PARKS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 573-864-8773
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------