Provider Demographics
NPI:1427773886
Name:PATRIOT PHYSICIAN SERVICES PLLC
Entity type:Organization
Organization Name:PATRIOT PHYSICIAN SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-730-5919
Mailing Address - Street 1:5261 CARROLLTON PIKE STE E
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24381-3034
Mailing Address - Country:US
Mailing Address - Phone:276-730-5919
Mailing Address - Fax:
Practice Address - Street 1:1719 ALBEMARLE BEACH RD
Practice Address - Street 2:
Practice Address - City:ROPER
Practice Address - State:NC
Practice Address - Zip Code:27970-9419
Practice Address - Country:US
Practice Address - Phone:276-730-5919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty