MEDICARE: VIRGINIA MEDICAL GROUP SLEEP CENTER, 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	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1427129147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA MEDICAL GROUP SLEEP CENTER, LLC

Provider Business Mailing Address
First Line	:	213 TEMPLE AVE
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2827
Country	:	US
Telephone Number	:	804-524-2260
Fax Number	:	804-524-0096

Provider Business Practice Location Address
First Line	:	213 TEMPLE AVE
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2827
Country	:	US
Telephone Number	:	804-526-0682
Fax Number	:

Authorized Official
Title or Position	:	MBR
Name	:	DR. ROBERT S. DAVIS
Credential	:	M.D.
Telephone Number	:	804-524-2260

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	12/21/2015

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