Provider Demographics
NPI:1720175953
Name:CENTRAL VIRGINIA FAMILY PHYSICIANS, INC
Entity type:Organization
Organization Name:CENTRAL VIRGINIA FAMILY PHYSICIANS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:STAFF CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-382-1139
Mailing Address - Street 1:PO BOX 2489
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-6489
Mailing Address - Country:US
Mailing Address - Phone:434-382-1139
Mailing Address - Fax:434-525-5748
Practice Address - Street 1:527 POCKET RD
Practice Address - Street 2:
Practice Address - City:HURT
Practice Address - State:VA
Practice Address - Zip Code:24563-2023
Practice Address - Country:US
Practice Address - Phone:434-324-9150
Practice Address - Fax:434-324-8248
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA FAMILY PHYSICIANS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-09
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1528155892Medicaid
VAC03658OtherCVFP MCARE GROUP PTAN
VACC2392OtherMEDICARE RAILROAD
VA1528155892OtherCVFP CORPORATE NPI
VA1528155892Medicaid
VAC05537Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER