Provider Demographics
NPI:1588782569
Name:HEALTHLINE FAMILY PRACTICE PC
Entity type:Organization
Organization Name:HEALTHLINE FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TUSHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-530-0707
Mailing Address - Street 1:13121 RIVERS BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-8624
Mailing Address - Country:US
Mailing Address - Phone:804-530-0707
Mailing Address - Fax:804-530-0074
Practice Address - Street 1:13121 RIVERS BEND BLVD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-8624
Practice Address - Country:US
Practice Address - Phone:804-530-0707
Practice Address - Fax:804-530-0074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005640563Medicaid
VA005640563Medicaid
VA080007924Medicare ID - Type Unspecified