MEDICARE: PRIMEDOC ST.FRANCIS 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	207R00000X	Internal Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE2863	OTHER	VA	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1346207024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMEDOC ST.FRANCIS PC

Provider Business Mailing Address
First Line	:	PO BOX 601799
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-1799
Country	:	US
Telephone Number	:	843-237-3378
Fax Number	:	843-237-5073

Provider Business Practice Location Address
First Line	:	13710 SAINT FRANCIS BLVD
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-3267
Country	:	US
Telephone Number	:	843-237-3378
Fax Number	:	843-237-5073

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT REYNOLDS
Credential	:	MD
Telephone Number	:	843-237-3378

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	03/16/2009

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