| Centerville Family Practice, P.c. | |
|
46 Broad Street Rd Suite A Manakin Sabot VA 23103-2213 | |
| (804) 708-9480 | |
| (804) 708-0865 |
| Full Name | Centerville Family Practice, P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 46 Broad Street Rd, Manakin Sabot, Virginia |
| Authorized Official Name and Position | Berta L. Granados Ortega (PRESIDENT) |
| Authorized Official Contact | 8047089480 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centerville Family Practice, P.c. Po Box 5275 Glen Allen VA 23058-5275 Ph: (804) 708-9480 | Centerville Family Practice, P.c. 46 Broad Street Rd Suite A Manakin Sabot VA 23103-2213 Ph: (804) 708-9480 |
| NPI Number | 1306241575 |
|---|---|
| Provider Enumeration Date | 10/29/2014 |
| Last Update Date | 02/09/2015 |
| Medicare PECOS PAC ID | 9133443021 |
|---|---|
| Medicare Enrollment ID | O20150126000106 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306241575 | NPI | - | NPPES |
| 1306241575 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0101248698 (Virginia) | Primary |
| Provider Name | Nelson Javier Chen Fernandez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417147315 PECOS PAC ID: 2062545478 Enrollment ID: I20110421000480 |
| Provider Name | Berta Lisbeth Granados Ortega |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760672661 PECOS PAC ID: 3274666714 Enrollment ID: I20110706000167 |
Integrated Therapy Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 40 Broad Street Rd, Manakin Sabot, VA 23103 Phone: 804-784-3514 | |
The Family Practice Of Manakin-sabot Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 294 River Rd W, Manakin Sabot, VA 23103 Phone: 804-784-8800 Fax: 804-784-7203 |