Provider Demographics
NPI:1497639835
Name:CHARLOTTESVILLE PRIMARY CARE AND INTEGRATIVE MEDICINE PLLC
Entity type:Organization
Organization Name:CHARLOTTESVILLE PRIMARY CARE AND INTEGRATIVE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS-SELKING
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:434-260-0235
Mailing Address - Street 1:2541 MONTGOMERY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-6329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2541 MONTGOMERY RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-6329
Practice Address - Country:US
Practice Address - Phone:434-260-0235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty