MEDICARE: MEDARVA PHYSICIAN SERVICES 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	207X00000X	Orthopaedic Surgery Physician
2	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1962768051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDARVA PHYSICIAN SERVICES LLC

Provider Business Mailing Address
First Line	:	8700 STONY POINT PKWY
Second Line	:	STE 100
City	:	RICHMOND
State	:	VA
Zip	:	23235-1962
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 MEDICAL PARK BLVD STE A
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-9289
Country	:	US
Telephone Number	:	804-775-4500
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	TONYA JENKINS
Credential	:
Telephone Number	:	804-775-4500

Provider Enumeration Date	:	04/03/2012
Last Update Date	:	08/07/2025

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