Provider Demographics
NPI:1124255914
Name:COURTHOUSE FAMILY PRACTICE PC
Entity type:Organization
Organization Name:COURTHOUSE FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-423-5050
Mailing Address - Street 1:1108 COURTHOUSE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3197
Mailing Address - Country:US
Mailing Address - Phone:804-423-5050
Mailing Address - Fax:804-423-5048
Practice Address - Street 1:1108 COURTHOUSE RD
Practice Address - Street 2:SUITE D
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-3197
Practice Address - Country:US
Practice Address - Phone:804-423-5050
Practice Address - Fax:804-423-5048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045480305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA256377OtherANTHEM
VA005602131Medicaid
VA113086OtherSOUTHERN HEALTH
VA4322278OtherAETNA HEALTHCARE
VA4322278OtherAETNA HEALTHCARE
VA256377OtherANTHEM