Organization
CMH ER PHYSICIANS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH LIBBY JR. (VP FINANCE)
(434) 447-3151
Entity
Organization
Contact information
Practice address
125 BUENA VISTA CIR, SOUTH HILL, VA 23970-1431
(434) 447-3151
Mailing address
PO BOX 12039, DAYTONA BEACH, FL 32120-2039
(434) 774-2400
(434) 774-2401
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
172719
ANTHEM BC/BS OF VA
—
01
—
23970
CHAMPUS
—
05
—
89013N4
—
NC
01
—
CJ8053
RAILROAD MEDICARE
—
Enumeration date
04/10/2006
Last updated
07/01/2014
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