MEDICARE: VIRGINIA PHS LLC

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

General Provider Information

NPI Number	:	1174838841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA PHS LLC

Provider Business Mailing Address
First Line	:	9155 CRESTWYN HILLS DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-8501
Country	:	US
Telephone Number	:	901-261-4848
Fax Number	:

Provider Business Practice Location Address
First Line	:	7001 LOISDALE RD
Second Line	:	SPRINGFIELD BUSINESS CENTER
City	:	SPRINGFIELD
State	:	VA
Zip	:	22150-1904
Country	:	US
Telephone Number	:	877-260-4747
Fax Number	:

Authorized Official
Title or Position	:	REVENUE CYCLE MANAGER
Name	:	TANYA NOAH
Credential	:
Telephone Number	:	901-261-4843

Provider Enumeration Date	:	08/18/2010
Last Update Date	:	08/18/2010

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