| James River Family Practice, Llc | |
|
11835 Fishing Point Dr Suite 104 Newport News VA 23606-2584 | |
| (757) 599-5588 | |
| (757) 599-6893 |
| Full Name | James River Family Practice, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 11835 Fishing Point Dr, Newport News, Virginia |
| Authorized Official Name and Position | Eric Robert Donald Kroetsch (REVENUE CYCLE MANAGER) |
| Authorized Official Contact | 8883602288 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| James River Family Practice, Llc 2511 N Hiatus Rd # 166 Hollywood FL 33026-1301 Ph: (757) 271-4091 | James River Family Practice, Llc 11835 Fishing Point Dr Suite 104 Newport News VA 23606-2584 Ph: (757) 599-5588 |
| NPI Number | 1427290352 |
|---|---|
| Provider Enumeration Date | 03/24/2009 |
| Last Update Date | 01/03/2024 |
| Medicare PECOS PAC ID | 6103977616 |
|---|---|
| Medicare Enrollment ID | O20090623000644 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427290352 | NPI | - | NPPES |
| 1902899016 | Medicaid | VA | |
| 1508086257 | Medicaid | VA | |
| 1659301430 | Other | ANTHEM BLUE CROSS AND BLUE SHIELD | |
| 14078914833 | Other | VA | ANTHEM BLUE CROSS AND BLUE SHIELD |
| 14078914833 | Medicaid | VA | |
| 1508086257 | Other | VA | ANTHEM BLUE CROSS AND BLUE SHIELD |
| 1659301430 | Medicaid | VA | |
| 1902899016 | Other | VA | ANTHEM BLUE CROSS AN BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | James Mathew Halverson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902899016 PECOS PAC ID: 3375430689 Enrollment ID: I20040302001313 |
| Provider Name | Jerome A Provenzano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891760039 PECOS PAC ID: 3971515388 Enrollment ID: I20060630000109 |
| Provider Name | Courtney Brooke Penn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275202095 PECOS PAC ID: 7517364219 Enrollment ID: I20210923000054 |
| Provider Name | Stephanie Michelle Cox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508510553 PECOS PAC ID: 5092109819 Enrollment ID: I20220221002225 |
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