Provider Demographics
NPI:1811064041
Name:SPRINGFIELD BURKE FAMILY PRACTICE
Entity type:Organization
Organization Name:SPRINGFIELD BURKE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLLING & CREDENTIALING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-971-1676
Mailing Address - Street 1:8991 COTSWOLD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015
Mailing Address - Country:US
Mailing Address - Phone:703-440-0107
Mailing Address - Fax:703-440-8246
Practice Address - Street 1:8991 COTSWOLD DRIVE
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015
Practice Address - Country:US
Practice Address - Phone:703-440-0107
Practice Address - Fax:703-440-8246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG00527Medicare ID - Type UnspecifiedTRAILBLAZERS HEALTH