Provider Demographics
NPI:1043692767
Name:NORTON COMMUNITY PHYSICIANS SERVICES LLC
Entity type:Organization
Organization Name:NORTON COMMUNITY PHYSICIANS SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-915-5185
Mailing Address - Street 1:98 15TH ST NW
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1600
Mailing Address - Country:US
Mailing Address - Phone:276-439-1493
Mailing Address - Fax:276-439-1494
Practice Address - Street 1:98 15TH ST NW
Practice Address - Street 2:SUITE 202
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1600
Practice Address - Country:US
Practice Address - Phone:276-439-1493
Practice Address - Fax:276-439-1494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Single Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1043692767Medicaid
VA622814800OtherDEPARTMENT OF LABOR
VAC10456Medicare PIN