MEDICARE: SANDY RIVER FAMILY CARE 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	0101053147	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CL9316	OTHER	VA	PALMETTO GBA MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	258015	OTHER	VA	ANTHEM BC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932354222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDY RIVER FAMILY CARE INC

Provider Business Mailing Address
First Line	:	309 S MAIN ST
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24541-2925
Country	:	US
Telephone Number	:	434-797-4150
Fax Number	:	434-797-1300

Provider Business Practice Location Address
First Line	:	4520 MEDICAL CENTER RD
Second Line	:
City	:	AXTON
State	:	VA
Zip	:	24054-2822
Country	:	US
Telephone Number	:	434-685-7095
Fax Number	:	434-797-1300

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAJENDRA S TRIVEDI
Credential	:	MD
Telephone Number	:	434-685-7095

Provider Enumeration Date	:	12/01/2008
Last Update Date	:	09/10/2013

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Directions to “SANDY RIVER FAMILY CARE INC ” Practice Location

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