# 1212 MED PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** 1212MED
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982470100
- **Authorized official:** DR. HENRY BURGESS MD (OWNER)
- **Authorized official phone:** (540) 682-3082

## Contact information

- **Practice address:** 405 E LABURNUM AVE STE 3, RICHMOND, VA 23222-2134
- **Practice address phone:** (540) 200-8821
- **Practice address fax:** (540) 779-7889
- **Mailing address:** 674 LEES GAP RD, FINCASTLE, VA 24090-3869
- **Mailing address phone:** (540) 682-3082

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/29/2023
- **Last updated:** 03/07/2024