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General NPI Number Information
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NPI Number | 1790230563
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE OF THE VIRGINIAS
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 08/22/2016
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Provider Practice Location Address
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Address Line | 2221 W CUMBERLAND RD
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City | BLUEFIELD
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State | VA
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Zip | 24605-2009
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Country | US
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Telephone | 276-322-7440
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Fax | 276-322-7347
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Provider Business Mailing Address
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Address Line | 2221 W CUMBERLAND RD
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City | BLUEFIELD
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State | VA
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Zip | 24605-2009
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Country | US
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Telephone | 276-322-7440
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Fax | 276-322-7347
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Authorized Official
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Title or Position | OWNER
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Name | KARA L BOWLING
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Credential | FNP-C
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Telephone | 276-322-7440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 363LF00000X
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License Number State | VA
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