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General NPI Number Information
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NPI Number | 1841452018
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Entity Type | Organization
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Legal Business Name | HEART OF VIRGINIA PC
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 26 BROAD ST
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City | MARTINSVILLE
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State | VA
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Zip | 24112-2802
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Country | US
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Telephone | 276-632-4200
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Fax | 276-634-5312
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Provider Business Mailing Address
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Address Line | 26 BROAD ST
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City | MARTINSVILLE
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State | VA
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Zip | 24112-2802
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Country | US
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Telephone | 276-632-4200
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Fax | 276-634-5312
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK A PAINTER
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Credential | M.D.
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Telephone | 276-632-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 0101042801
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License Number State | VA
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