Provider Demographics
NPI:1962768051
Name:MEDARVA PHYSICIAN SERVICES LLC
Entity type:Organization
Organization Name:MEDARVA PHYSICIAN SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAYLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOZKURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-775-4500
Mailing Address - Street 1:8700 STONY POINT PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-1962
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 MEDICAL PARK BLVD STE A
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9289
Practice Address - Country:US
Practice Address - Phone:804-775-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHMOND EYE AND EAR HEALTHCARE ALLIANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-03
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty