Provider Demographics
NPI:1063540888
Name:FAMILYCARE IN THE PLAINS, INC
Entity type:Organization
Organization Name:FAMILYCARE IN THE PLAINS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TOMMI
Authorized Official - Middle Name:HURST
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-253-5776
Mailing Address - Street 1:4305 FAUQUIER AVE
Mailing Address - Street 2:
Mailing Address - City:THE PLAINS
Mailing Address - State:VA
Mailing Address - Zip Code:20198-0424
Mailing Address - Country:US
Mailing Address - Phone:540-253-5776
Mailing Address - Fax:540-253-5797
Practice Address - Street 1:4305 FAUQUIER AVE
Practice Address - Street 2:
Practice Address - City:THE PLAINS
Practice Address - State:VA
Practice Address - Zip Code:20198-0424
Practice Address - Country:US
Practice Address - Phone:540-253-5776
Practice Address - Fax:540-253-5797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023772207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE55941Medicare UPIN
VAC05616Medicare PIN