Provider Demographics
NPI:1386802031
Name:RADFORD FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:RADFORD FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-650-2307
Mailing Address - Street 1:600 E MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-1826
Mailing Address - Country:US
Mailing Address - Phone:540-633-3980
Mailing Address - Fax:540-633-3985
Practice Address - Street 1:600 E MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1826
Practice Address - Country:US
Practice Address - Phone:540-633-3980
Practice Address - Fax:540-633-3985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10584Medicare PIN