Provider Demographics
NPI:1447893953
Name:FAMILY MEDICINE ASSOCIATES OF NORTH STAFFORD
Entity type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES OF NORTH STAFFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-281-4720
Mailing Address - Street 1:2761 JEFFERSON DAVIS HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8330
Mailing Address - Country:US
Mailing Address - Phone:540-786-2100
Mailing Address - Fax:
Practice Address - Street 1:2761 JEFFERSON DAVIS HWY STE 101
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8330
Practice Address - Country:US
Practice Address - Phone:909-281-4720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010211689Medicaid
VA541595397OtherTRICARE