Basic Information
| Provider Information | |||||||||
| NPI: | 1053712604 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAMES RIVER CARDIOLOGY, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13000 RIVERS BEND BLVD STE D | ||||||||
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| City: | CHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238368632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045715000 | ||||||||
| FaxNumber: | 8045181314 | ||||||||
| Practice Location | |||||||||
| Address1: | 9782 HIGHWAY NINE O THREE | ||||||||
| Address2: | |||||||||
| City: | BRACEY | ||||||||
| State: | VA | ||||||||
| PostalCode: | 239191991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4346366903 | ||||||||
| FaxNumber: | 8667813220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2014 | ||||||||
| LastUpdateDate: | 09/12/2014 | ||||||||
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| AuthorizedOfficialLastName: | AMIN | ||||||||
| AuthorizedOfficialFirstName: | MITESH | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8045201764 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 0101237240 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 1407157647 | 05 | VA | MEDICAID |