# PETERSBURG CLINIC COMPANY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881643617
- **Authorized official:** DEBBIE BREWER (DIRECTOR)
- **Authorized official phone:** (877) 892-9813

## Contact information

- **Practice address:** 200 MEDICAL PARK BLVD, PETERSBURG, VA 23805-9274
- **Practice address phone:** (804) 765-5991
- **Mailing address:** PO BOX 689022, FRANKLIN, TN 37068-9022

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RG0100X | Gastroenterology Physician | — | NULL | — |
| 207RG0100X | Gastroenterology Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 208VP0000X | Pain Medicine Physician | — | NULL | — |
| 208VP0000X | Pain Medicine Physician | — | — | — |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/09/2006
- **Last updated:** 06/30/2011