MEDICARE: COLLABORATIVE HEALTH PARTNERS, 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	:	1972975175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLABORATIVE HEALTH PARTNERS, LLC

Provider Business Mailing Address
First Line	:	1111 CORPORATE PARK DR STE D
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-2279
Country	:	US
Telephone Number	:	434-382-1125
Fax Number	:	434-525-6738

Provider Business Practice Location Address
First Line	:	1111 CORPORATE PARK DR STE D
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-2279
Country	:	US
Telephone Number	:	434-382-1125
Fax Number	:	434-525-6738

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS W EPPES
Credential	:	MD
Telephone Number	:	434-382-1125

Provider Enumeration Date	:	10/27/2015
Last Update Date	:	10/27/2015

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