Provider Demographics
NPI:1194176727
Name:CENTRAL VIRGINIA FAMILY PHYSICIANS, INC.
Entity type:Organization
Organization Name:CENTRAL VIRGINIA FAMILY PHYSICIANS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:STAFF CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-382-1139
Mailing Address - Street 1:1971 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 1895
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24515-0002
Mailing Address - Country:US
Mailing Address - Phone:434-338-7180
Mailing Address - Fax:434-338-7781
Practice Address - Street 1:1971 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 1895
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24515-0002
Practice Address - Country:US
Practice Address - Phone:434-338-7180
Practice Address - Fax:434-338-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC0368Medicare PIN