Provider Demographics
NPI:1588742225
Name:SPRINGBROOK FAMILY MEDICINE
Entity type:Organization
Organization Name:SPRINGBROOK FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:REID
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:540-896-5400
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:VA
Mailing Address - Zip Code:22815-0309
Mailing Address - Country:US
Mailing Address - Phone:540-896-5400
Mailing Address - Fax:540-896-9923
Practice Address - Street 1:173 EAST SPRINGBROOK RD
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:VA
Practice Address - Zip Code:22815
Practice Address - Country:US
Practice Address - Phone:540-896-5400
Practice Address - Fax:540-896-9923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00000261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherTAX ID
VA=========OtherTAX ID