Provider Demographics
NPI:1427290352
Name:JAMES RIVER FAMILY PRACTICE, LLC
Entity type:Organization
Organization Name:JAMES RIVER FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:KROETSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-360-2288
Mailing Address - Street 1:1007 N FEDERAL HWY # 381
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1422
Mailing Address - Country:US
Mailing Address - Phone:757-271-4091
Mailing Address - Fax:888-818-1230
Practice Address - Street 1:11835 FISHING POINT DR
Practice Address - Street 2:SUITE 104
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2584
Practice Address - Country:US
Practice Address - Phone:757-599-5588
Practice Address - Fax:757-599-6893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508086257OtherANTHEM BLUE CROSS AND BLUE SHIELD
VA1659301430Medicaid
VA1902899016OtherANTHEM BLUE CROSS AN BLUE SHIELD
VA1902899016Medicaid
VA14078914833OtherANTHEM BLUE CROSS AND BLUE SHIELD
VA14078914833Medicaid
VA1508086257Medicaid
1659301430OtherANTHEM BLUE CROSS AND BLUE SHIELD
VA1508086257OtherANTHEM BLUE CROSS AND BLUE SHIELD
1659301430OtherANTHEM BLUE CROSS AND BLUE SHIELD
VA14078914833Medicaid
VA14078914833OtherANTHEM BLUE CROSS AND BLUE SHIELD