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Organization

MED ATLANTIC INC

Active
Other names
Med Atlantic Inc dba Urosurgical Ctr Of Richmond
Organization subpart
No

Provider details

NPI number
Authorized official
MR. TERRY COFFEY (ADMINISTRATOR)
(804) 287-6100
Entity
Organization

Contact information

Practice address
8228 MEADOWBRIDGE RD, MECHANICSVILLE, VA 23116-2331
(804) 730-5023
Mailing address
9105 STONY POINT PKWY, RICHMOND, VA 23235-1979
(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
160657
SOUTHERN HEALTH
VA
Enumeration date
07/17/2006
Last updated
03/22/2013
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