Provider Demographics
NPI:1598949745
Name:GRIFFITH CLINIC A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:GRIFFITH CLINIC A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:FEAGANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-885-1045
Mailing Address - Street 1:PO BOX 31354
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-1354
Mailing Address - Country:US
Mailing Address - Phone:804-472-2477
Mailing Address - Fax:804-472-3124
Practice Address - Street 1:5962 COPLE HWY
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:VA
Practice Address - Zip Code:22524-9999
Practice Address - Country:US
Practice Address - Phone:804-472-2477
Practice Address - Fax:804-472-3154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101012891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5608716Medicaid
VA034169OtherANTHEM BLUE CROSS
VA080066928OtherRAILROAD MEDICARE
VA080004730Medicare Oscar/Certification
VA034169OtherANTHEM BLUE CROSS