Basic Information
| Provider Information | |||||||||
| NPI: | 1619246733 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEART SPECIALISTS OF RICHMOND, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 W LEIGH ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232203200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045622769 | ||||||||
| FaxNumber: | 8042693406 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 W LEIGH ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232203200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045622769 | ||||||||
| FaxNumber: | 8042693406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2011 | ||||||||
| LastUpdateDate: | 12/19/2011 | ||||||||
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| AuthorizedOfficialLastName: | SHIELDS | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8042829133 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 0101034738 | VA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 1306815105 | 05 | VA | MEDICAID |