Organization
BROADWAY FAMILY PRACTICE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE A BENTREM II MD (OWNER)
(540) 896-7061
Entity
Organization
Contact information
Practice address
12515 TIMBERWAY, BROADWAY, VA 22815
(540) 896-7061
(540) 896-7062
Mailing address
P. O. BOX 6, BROADWAY, VA 22815
(540) 896-7061
(540) 896-7062
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101054180
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5619734
—
VA
Enumeration date
10/03/2006
Last updated
05/02/2008
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