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Organization
MED ATLANTIC INC
Active
Organization
MED ATLANTIC INC
Active
Other names
Med Atlantic Inc dba Urosurgical Ctr Of Richmond
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY COFFEY (ADMINISTRATOR)
(804) 287-6100
Entity
Organization
Contact information
Practice address
8228 MEADOWBRIDGE RD, MECHANICSVILLE, VA 23116-2331
(804) 730-5023
Mailing address
9105 STONY POINT PKWY, RICHMOND, VA 23235-1979
(804) 287-6100
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
OH679
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007631405
—
VA
01
—
0597537
AETNA PPO
VA
01
—
160657
SOUTHERN HEALTH
VA
Enumeration date
07/17/2006
Last updated
03/22/2013
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