MEDICARE: EVMS ACADEMIC PHYSICIANS AND SURGEONS HEALTH SERVICES FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207N00000X	Dermatology Physician
2	207Q00000X	Family Medicine Physician
3	207V00000X	Obstetrics & Gynecology Physician
4	207W00000X	Ophthalmology Physician
5	207Y00000X	Otolaryngology Physician
6	208100000X	Physical Medicine & Rehabilitation Physician
7	208200000X	Plastic Surgery Physician
8	2084P0800X	Psychiatry Physician
9	2085R0001X	Radiation Oncology Physician
10	208600000X	Surgery Physician
11	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1003887118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVMS ACADEMIC PHYSICIANS AND SURGEONS HEALTH SERVICES FOUNDATION

Provider Business Mailing Address
First Line	:	PO BOX 936
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23501-0936
Country	:	US
Telephone Number	:	757-451-6200
Fax Number	:	757-451-6251

Provider Business Practice Location Address
First Line	:	4111 MONARCH WAY
Second Line	:	SUITE 500
City	:	NORFOLK
State	:	VA
Zip	:	23508-2559
Country	:	US
Telephone Number	:	757-451-6200
Fax Number	:	757-451-6251

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. JAMES F LIND JR.
Credential	:
Telephone Number	:	757-451-6200

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	05/28/2013

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