# BROADWAY FAMILY PRACTICE, PC

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

## Provider details

- **NPI number:** 1891880217
- **Authorized official:** DR. GEORGE A BENTREM II MD (OWNER)
- **Authorized official phone:** (540) 896-7061

## Contact information

- **Practice address:** 12515 TIMBERWAY, BROADWAY, VA 22815
- **Practice address phone:** (540) 896-7061
- **Practice address fax:** (540) 896-7062
- **Mailing address:** P. O. BOX 6, BROADWAY, VA 22815
- **Mailing address phone:** (540) 896-7061
- **Mailing address fax:** (540) 896-7062

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 0101054180 | VA | Yes |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 05/02/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5619734 | — | VA |