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Organization
ABINGDON FAMILY PRACTICE PC
Active
Organization
ABINGDON FAMILY PRACTICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIMON P PENNINGS (PRESIDENT)
(276) 628-1186
Entity
Organization
Contact information
Practice address
617 CAMPUS DR, ABINGDON, VA 24210-9700
(276) 628-1186
(276) 628-8507
Mailing address
617 CAMPUS DR, ABINGDON, VA 24210-9700
(276) 628-1186
(276) 628-8507
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005607531
—
VA
05
—
005641802
—
VA
05
—
005642507
—
VA
01
—
064411
ANTHEM
—
01
—
2102748
MAMSI
—
01
—
226900
ANTHEM
—
01
—
3054602
BLUE CLASSIE
—
01
—
460464
ANTHEM
—
01
—
5603067
AETNA
—
01
—
5752880001
MEDICARE NCS
VA
01
—
5756306
AETNA
—
01
—
C03006
MEDICARE PROVIDER
VA
Enumeration date
10/14/2005
Last updated
06/16/2008
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