MEDICARE: VIRGINIA UROLOGY CENTER PC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1073830444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA UROLOGY CENTER PC

Provider Business Mailing Address
First Line	:	9105 STONY POINT DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-1999
Country	:	US
Telephone Number	:	804-287-6101
Fax Number	:	804-288-3529

Provider Business Practice Location Address
First Line	:	9105 STONY POINT DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-1999
Country	:	US
Telephone Number	:	804-287-6101
Fax Number	:	804-288-3529

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. TERRY COFFEY
Credential	:
Telephone Number	:	804-287-6101

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	04/26/2010

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