Provider Demographics
NPI:1215940507
Name:CHILDREN'S MEDICAL GROUP, INC., D/B/A COURTHOUSE PEDIATRICS
Entity type:Organization
Organization Name:CHILDREN'S MEDICAL GROUP, INC., D/B/A COURTHOUSE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ABSHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-668-8565
Mailing Address - Street 1:PO BOX 800
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-0800
Mailing Address - Country:US
Mailing Address - Phone:804-695-0305
Mailing Address - Fax:804-695-0804
Practice Address - Street 1:8264 GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-4127
Practice Address - Country:US
Practice Address - Phone:804-695-0305
Practice Address - Fax:804-695-0804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026966208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty