Organization
JOHN RANDOLPH FAMILY PRACTICE LLC
Active
Other names
Chester Medical Group, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL SMITH (VICE PRESIDENT)
(804) 237-7760
Entity
Organization
Contact information
Practice address
12900 JEFFERSON DAVIS HWY, CHESTER, VA 23831-5311
(804) 414-0300
(804) 414-0319
Mailing address
12900 JEFFERSON DAVIS HWY, CHESTER, VA 23831-5311
(804) 414-0300
(804) 414-0319
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659330843
—
VA
01
—
DF58380
RR MEDICARE
VA
Enumeration date
03/17/2006
Last updated
06/17/2009
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