Basic Information
| Provider Information | |||||||||
| NPI: | 1972975175 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COLLABORATIVE HEALTH PARTNERS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 CORPORATE PARK DR STE D | ||||||||
| Address2: | |||||||||
| City: | FOREST | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245512279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4343821125 | ||||||||
| FaxNumber: | 4345256738 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 CORPORATE PARK DR STE D | ||||||||
| Address2: | |||||||||
| City: | FOREST | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245512279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4343821125 | ||||||||
| FaxNumber: | 4345256738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2015 | ||||||||
| LastUpdateDate: | 10/27/2015 | ||||||||
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| AuthorizedOfficialLastName: | EPPES | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4343821125 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.