Provider Demographics
NPI:1396745915
Name:FAMILY MEDICAL PRACTITIONERS, INC
Entity type:Organization
Organization Name:FAMILY MEDICAL PRACTITIONERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCT MAN
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAMBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-460-1207
Mailing Address - Street 1:1147 INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5545
Mailing Address - Country:US
Mailing Address - Phone:757-460-1207
Mailing Address - Fax:757-460-2136
Practice Address - Street 1:1147 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5545
Practice Address - Country:US
Practice Address - Phone:757-460-1207
Practice Address - Fax:757-460-2136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC03179OtherGROUP NUMBER
VAC03179OtherGROUP NUMBER
D1064Medicare ID - Type UnspecifiedRR