Provider Demographics
NPI:1063589448
Name:PATRICK COUNTY FAMILY PRACTICE PC
Entity type:Organization
Organization Name:PATRICK COUNTY FAMILY PRACTICE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CLAUDE
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-694-4466
Mailing Address - Street 1:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-1019
Mailing Address - Country:US
Mailing Address - Phone:276-694-4466
Mailing Address - Fax:276-694-2909
Practice Address - Street 1:18877 JEB STUART HIGHWAY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-1019
Practice Address - Country:US
Practice Address - Phone:276-694-4466
Practice Address - Fax:276-694-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1972500668OtherRICHARD C.COLE,M.D.
1871590562OtherKIMBERLY D.COMPTON, PA
VA7610289Medicaid
1861499691OtherELIZABETH A.SHOCKLEY, NP
1972500668OtherRICHARD C.COLE,M.D.
VA493830Medicare ID - Type UnspecifiedPATRICK CO FAMPRAC STUART
1871590562OtherKIMBERLY D.COMPTON, PA
VA7610289Medicaid
VAI38924Medicare UPIN