Organization
MEMORIAL FAMILY CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAMARA R NEAL (BILLING MANAGER)
(434) 792-3730
Entity
Organization
Contact information
Practice address
501 RISON ST, SUITE 120, DANVILLE, VA 24541-2425
(434) 792-3730
(434) 792-6048
Mailing address
PO BOX 10399, DANVILLE, VA 24543-5007
(434) 792-3730
(434) 792-6048
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101053147
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005619505
—
VA
01
—
258015
ANTHEM
VA
01
—
89063VU
EDS NC MEDICAID
NC
01
—
CL9316
PALMETTO GBA MEDICARE
VA
Enumeration date
03/04/2006
Last updated
04/18/2013
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