Basic Information
| Provider Information | |||||||||
| NPI: | 1760959357 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REDBUD FAMILY MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1048 TERRACE DR | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243544138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767831827 | ||||||||
| FaxNumber: | 2767832879 | ||||||||
| Practice Location | |||||||||
| Address1: | 5296 REDBUD HWY | ||||||||
| Address2: | |||||||||
| City: | HONAKER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242607379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2769919500 | ||||||||
| FaxNumber: | 2769914399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2018 | ||||||||
| LastUpdateDate: | 11/01/2018 | ||||||||
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| AuthorizedOfficialLastName: | STEVENS | ||||||||
| AuthorizedOfficialFirstName: | VICKIE | ||||||||
| AuthorizedOfficialMiddleName: | LYNNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2767305782 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | FNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.