Provider Demographics
NPI:1992889356
Name:ROCKBRIDGE MEDICAL GROUP, INC
Entity type:Organization
Organization Name:ROCKBRIDGE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETT-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-463-5055
Mailing Address - Street 1:204 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-2718
Mailing Address - Country:US
Mailing Address - Phone:540-463-5055
Mailing Address - Fax:540-463-1079
Practice Address - Street 1:204 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2718
Practice Address - Country:US
Practice Address - Phone:540-463-5055
Practice Address - Fax:540-463-1079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1992889356Medicaid