Provider Demographics
NPI:1558497297
Name:CHILDRENS MEDICAL CENTER LTD
Entity type:Organization
Organization Name:CHILDRENS MEDICAL CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CHILDRENS MEDICAL CENTER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAFAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-632-9714
Mailing Address - Street 1:15 CLEVELAND AVENUE
Mailing Address - Street 2:SUITE 14 CHILDREN MEDICAL CENTER LTD
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112
Mailing Address - Country:US
Mailing Address - Phone:276-632-9714
Mailing Address - Fax:276-632-0620
Practice Address - Street 1:15 CLEVELAND AVENUE
Practice Address - Street 2:SUITE 14 CHILDREN MEDICAL CENTER LTD
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112
Practice Address - Country:US
Practice Address - Phone:276-632-9714
Practice Address - Fax:276-632-0620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty