Provider Demographics
NPI:1316919582
Name:INTERNAL MEDICINE AND ENDOCRINOLOGY OF CENTRAL VIRGINIA
Entity type:Organization
Organization Name:INTERNAL MEDICINE AND ENDOCRINOLOGY OF CENTRAL VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-947-5959
Mailing Address - Street 1:1901 THOMSON DRIVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1008
Mailing Address - Country:US
Mailing Address - Phone:434-947-5959
Mailing Address - Fax:434-924-1293
Practice Address - Street 1:1901 THOMSON DRIVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1008
Practice Address - Country:US
Practice Address - Phone:434-947-5959
Practice Address - Fax:434-924-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057596207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5813271Medicaid
VAG070990Medicare UPIN