Provider Demographics
NPI:1447376710
Name:VIRGINIA UROLOGY CENTER-HOPEWELL
Entity type:Organization
Organization Name:VIRGINIA UROLOGY CENTER-HOPEWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-287-1030
Mailing Address - Street 1:102 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-2719
Mailing Address - Country:US
Mailing Address - Phone:804-458-7943
Mailing Address - Fax:804-541-7672
Practice Address - Street 1:102 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2719
Practice Address - Country:US
Practice Address - Phone:804-458-7943
Practice Address - Fax:804-541-7672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0419750005332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0419750005Medicare NSC