| 1212 Med Pllc | |
|
405 E Laburnum Ave Ste 3 Richmond VA 23222-2134 | |
| (540) 200-8821 | |
| (540) 779-7889 |
| Full Name | 1212 Med Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 405 E Laburnum Ave Ste 3, Richmond, Virginia |
| Authorized Official Name and Position | Henry Burgess (OWNER) |
| Authorized Official Contact | 5406823082 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 1212 Med Pllc 674 Lees Gap Rd Fincastle VA 24090-3869 Ph: (540) 682-3082 | 1212 Med Pllc 405 E Laburnum Ave Ste 3 Richmond VA 23222-2134 Ph: (540) 200-8821 |
| NPI Number | 1982470100 |
|---|---|
| Provider Enumeration Date | 11/29/2023 |
| Last Update Date | 03/07/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982470100 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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