Organization
MED ATLANTIC INC
Active
Other names
Med Atlantic Inc dba Urosurgical Ctr Of Richmond
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRIGETTE BOOTH (ADMINISTRATOR)
(804) 287-6100
Entity
Organization
Contact information
Practice address
9101 STONY POINT PKWY, RICHMOND, VA 23235-2002
(804) 287-6100
Mailing address
9101 STONY POINT PKWY, RICHMOND, VA 23235-2002
(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
—
490000221
RAILROAD MEDICARE
VA
Enumeration date
07/13/2006
Last updated
09/12/2018
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