Provider Demographics
NPI:1306995717
Name:STEPHENS CITY FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:STEPHENS CITY FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-868-4100
Mailing Address - Street 1:370 FAIRFAX PIKE
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-2968
Mailing Address - Country:US
Mailing Address - Phone:540-868-4100
Mailing Address - Fax:540-868-0888
Practice Address - Street 1:370 FAIRFAX PIKE
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-2968
Practice Address - Country:US
Practice Address - Phone:540-868-4100
Practice Address - Fax:540-868-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233394207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA129363OtherCOMMUNITY HEALTH
VA1306995717Medicaid
VA137797OtherANTHEM
VA7650702OtherAETNA
VA1306995717Medicaid
VA7650702OtherAETNA