| Broadway Family Practice, Pc | |
|
12515 Timberway Broadway VA 22815 | |
| (540) 896-7061 | |
| (540) 896-7062 |
| Full Name | Broadway Family Practice, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 12515 Timberway, Broadway, Virginia |
| Authorized Official Name and Position | George A Bentrem (OWNER) |
| Authorized Official Contact | 5408967061 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadway Family Practice, Pc P. O. Box 6 Broadway VA 22815 Ph: (540) 896-7061 | Broadway Family Practice, Pc 12515 Timberway Broadway VA 22815 Ph: (540) 896-7061 |
| NPI Number | 1891880217 |
|---|---|
| Provider Enumeration Date | 10/03/2006 |
| Last Update Date | 05/02/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891880217 | NPI | - | NPPES |
| 5619734 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0101054180 (Virginia) | Primary |
Springbrook Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 173 East Springbrook Rd, Broadway, VA 22815 Phone: 540-896-5400 Fax: 540-896-9923 |