Basic Information
| Provider Information | |||||||||
| NPI: | 1811914872 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAMES RIVER FAMILY PRACTICE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12420 WARWICK BLVD | ||||||||
| Address2: | 7B | ||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236063001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575995588 | ||||||||
| FaxNumber: | 7575996893 | ||||||||
| Practice Location | |||||||||
| Address1: | 12420 WARWICK BLVD | ||||||||
| Address2: | 7B | ||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236063001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575995588 | ||||||||
| FaxNumber: | 7575996893 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 04/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | HALVERSON | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | MATTHEW | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7575995588 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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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.