Provider Demographics
NPI:1962586461
Name:SPIVEY, JOHN C (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:SPIVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 CARE WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8425
Mailing Address - Country:US
Mailing Address - Phone:540-371-7600
Mailing Address - Fax:
Practice Address - Street 1:1031 CARE WAY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8425
Practice Address - Country:US
Practice Address - Phone:540-371-7600
Practice Address - Fax:540-371-2046
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101018720173000000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10806OtherSENTARA
VA0002OtherCAREFIRST
VA169553OtherANTHEM BCBS
VA201718482OtherVMA S/HEALTH CARENET
VA201718482011OtherCHAMPUS/TRICARE
VA4091856OtherAETNA
VA250916OtherSOUTHERN HEALTH
VA100006740OtherRAILROAD MEDICARE
VA3730259OtherAENTA HMO
VA477493OtherMAMSI
VA010272017Medicaid
VA477493OtherUNITED HEALTHCARE
VA010272017Medicaid
VA250916OtherSOUTHERN HEALTH