| Vita Family Medicine And Medspa Llc | |
|
540 Fort Evans Rd Suite 204 Leesburg VA 20176-3379 | |
| (703) 737-3500 | |
| (703) 737-3550 |
| Full Name | Vita Family Medicine And Medspa Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 540 Fort Evans Rd, Leesburg, Virginia |
| Authorized Official Name and Position | Jennifer Boudreau (OWNER/DOCTOR) |
| Authorized Official Contact | 7178058264 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vita Family Medicine And Medspa Llc 540 Fort Evans Rd Suite 204 Leesburg VA 20176-3379 Ph: (703) 737-3500 | Vita Family Medicine And Medspa Llc 540 Fort Evans Rd Suite 204 Leesburg VA 20176-3379 Ph: (703) 737-3500 |
| NPI Number | 1730532359 |
|---|---|
| Provider Enumeration Date | 07/19/2016 |
| Last Update Date | 10/13/2016 |
| Medicare PECOS PAC ID | 4688962442 |
|---|---|
| Medicare Enrollment ID | O20161011000603 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730532359 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 0101258315 (Virginia) | Secondary |
| 207Q00000X | Family Medicine | (Virginia) | Primary |
| Provider Name | Jennifer B Boudreau |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811216021 PECOS PAC ID: 2466696448 Enrollment ID: I20150908002772 |
| Provider Name | Erica Shackelford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902375694 PECOS PAC ID: 0244578060 Enrollment ID: I20190220001649 |
Loudoun Medical Group, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 19450 Deerfield Avenue, Suite 200, Leesburg, VA 20176 Phone: 703-844-8380 Fax: 703-263-8393 | |
Loudoun Medical Group, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 211 Gibson Street, Nw, Suite 215, Leesburg, VA 20176 Phone: 571-707-2079 Fax: 571-291-9196 | |
Northern Virginia Acupuncture Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 211 S King St Ste C, Leesburg, VA 20175 Phone: 571-417-8463 | |
Dulles Medical Group Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 224d Cornwall St Nw, Suite 303, Leesburg, VA 20176 Phone: 703-777-8840 Fax: 703-779-0887 | |
Mediluxe Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 19349 Diamond Lake Dr, Leesburg, VA 20176 Phone: 571-283-1124 | |
Patient First Richmond Medical Group Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 601 Potomac Station Dr Ne, Leesburg, VA 20176 Phone: 703-840-1396 Fax: 703-840-1397 | |
Loudoun Medical Group, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 19490 Sandridge Way, Suite 240, Leesburg, VA 20176 Phone: 571-223-5723 Fax: 703-724-0941 |