Provider Demographics
NPI:1699869487
Name:SUTHERLAND FAMILY PRACTICE INC.
Entity type:Organization
Organization Name:SUTHERLAND FAMILY PRACTICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:804-265-5211
Mailing Address - Street 1:5609 CLAIBORNE RD
Mailing Address - Street 2:
Mailing Address - City:SUTHERLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23885-9303
Mailing Address - Country:US
Mailing Address - Phone:804-265-5211
Mailing Address - Fax:804-265-2707
Practice Address - Street 1:5609 CLAIBORNE RD
Practice Address - Street 2:
Practice Address - City:SUTHERLAND
Practice Address - State:VA
Practice Address - Zip Code:23885-9303
Practice Address - Country:US
Practice Address - Phone:804-265-5211
Practice Address - Fax:804-265-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC04463Medicare PIN