Organization
CH VA COLLABORATIVE CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA M COOKE (CHIEF FINANCIAL OFFICER)
(972) 715-3808
Entity
Organization
Contact information
Practice address
4099 BASSWOOD RD, DISPUTANTA, VA 23842-4517
(571) 781-7001
(888) 722-4282
Mailing address
4055 VALLEY VIEW LN, SUITE 400, DALLAS, TX 75244-5074
(972) 715-3800
(888) 722-4282
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E110
MEDICARE CERTIFICATION NUMBER
VA
Enumeration date
09/05/2014
Last updated
02/10/2015
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