Provider Demographics
NPI:1396330064
Name:EMERGENCY PHYSICIANS IMMEDIATE CARE CENTER 1 PLLC
Entity type:Organization
Organization Name:EMERGENCY PHYSICIANS IMMEDIATE CARE CENTER 1 PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:JEANNETTE
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-437-0255
Mailing Address - Street 1:12214 W BROAD ST STE B
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1062
Mailing Address - Country:US
Mailing Address - Phone:804-362-8345
Mailing Address - Fax:855-224-1594
Practice Address - Street 1:12214 W BROAD ST STE B
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1062
Practice Address - Country:US
Practice Address - Phone:804-362-8345
Practice Address - Fax:855-224-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory