Basic Information
| Provider Information | |||||||||
| NPI: | 1073646501 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RETREAT CARDIOLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 W LEIGH ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232203200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047880004 | ||||||||
| FaxNumber: | 8046435935 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 W LEIGH ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232203200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047880004 | ||||||||
| FaxNumber: | 8046435935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 04/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 8042377760 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.