Provider Demographics
NPI:1427108711
Name:TAZEWELL FAMILY HEALTHECARE PC
Entity type:Organization
Organization Name:TAZEWELL FAMILY HEALTHECARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:K
Authorized Official - Last Name:DUTY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP C
Authorized Official - Phone:276-988-4400
Mailing Address - Street 1:PO BOX 948
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-0948
Mailing Address - Country:US
Mailing Address - Phone:276-988-4400
Mailing Address - Fax:276-988-5600
Practice Address - Street 1:840 E FINCASTLE ST
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-1419
Practice Address - Country:US
Practice Address - Phone:276-988-4400
Practice Address - Fax:276-988-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024000084261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010006601Medicaid
VA00V557T96Medicare ID - Type Unspecified
VA010006601Medicaid