Basic Information
| Provider Information | |||||||||
| NPI: | 1467533877 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FIRST MED, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 RIVERBEND DR | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229118695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349844200 | ||||||||
| FaxNumber: | 4349846242 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 RIVERBEND DR | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229118695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349844200 | ||||||||
| FaxNumber: | 4349846242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TALBOTT | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4349844200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 0101034548 | VA | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | VA | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1720055767 | 05 | VA | MEDICAID | 1568439040 | 05 | VA | MEDICAID |