MEDICARE: FAMILYCARE IN THE PLAINS, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101023772	VA

General Provider Information

NPI Number	:	1063540888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILYCARE IN THE PLAINS, INC

Provider Business Mailing Address
First Line	:	4305 FAUQUIER AVE
Second Line	:
City	:	THE PLAINS
State	:	VA
Zip	:	20198-0424
Country	:	US
Telephone Number	:	540-253-5776
Fax Number	:	540-253-5797

Provider Business Practice Location Address
First Line	:	4305 FAUQUIER AVE
Second Line	:
City	:	THE PLAINS
State	:	VA
Zip	:	20198-0424
Country	:	US
Telephone Number	:	540-253-5776
Fax Number	:	540-253-5797

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	TOMMI HURST EDWARDS
Credential	:
Telephone Number	:	540-253-5776

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	02/04/2008

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