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General NPI Number Information
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NPI Number | 1972772929
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Entity Type | Organization
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Legal Business Name | SUGAR HOLLOW MEDICAL
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 3177 LINDEN DR SUITE #6
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City | BRISTOL
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State | VA
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Zip | 24202-5812
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Country | US
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Telephone | 276-466-3777
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Fax | 276-466-3705
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Provider Business Mailing Address
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Address Line | 3177 LINDEN DR SUITE #6
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City | BRISTOL
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State | VA
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Zip | 24202-5812
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Country | US
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Telephone | 276-466-3777
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Fax | 276-466-3705
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID P GULDSETH
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Credential | MD
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Telephone | 276-466-3777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 0101231449
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101231449
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License Number State | VA
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