Organization
SANDY RIVER FAMILY CARE INC
Active
Parent organization
MEMORIAL FAMILY CARE INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEMORIAL FAMILY CARE INC
Authorized official
RAJENDRA S TRIVEDI MD (PRESIDENT)
(434) 685-7095
Entity
Organization
Contact information
Practice address
4520 MEDICAL CENTER RD, AXTON, VA 24054-2822
(434) 685-7095
(434) 797-1300
Mailing address
309 S MAIN ST, DANVILLE, VA 24541-2925
(434) 797-4150
(434) 797-1300
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 BC
VA
01
—
89063VU
MEDICAID NC
NC
01
—
CL9316
PALMETTO GBA MEDICARE
VA
Enumeration date
12/01/2008
Last updated
09/10/2013
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