Basic Information
| Provider Information | |||||||||
| NPI: | 1730425828 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOCUS RICHMOND LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FOCUS MD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8159 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366890159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514145810 | ||||||||
| FaxNumber: | 2514145809 | ||||||||
| Practice Location | |||||||||
| Address1: | 9137 CHAMBERLAYNE RD | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | MECHANICSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231162534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514145810 | ||||||||
| FaxNumber: | 2514145809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2012 | ||||||||
| LastUpdateDate: | 12/18/2012 | ||||||||
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| AuthorizedOfficialLastName: | COLE | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 2513002060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.