Organization · NPI-2

1212 Med PLLC

Family Medicine · Richmond, VA

NPI number1982470100
StatusActive
Last updated in NPPESMar 7, 2024

Details

NPI
1982470100
Entity type
Organization (NPI-2)
Legal business name
1212 Med PLLC
Organization subpart
No
Enumeration date
Nov 29, 2023
Certification date
Mar 7, 2024
Last updated
Mar 7, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine––Yes

Other names

  • 1212med (Doing Business As)

Practice location

405 E Laburnum Ave Ste 3
Richmond, VA 23222-2134

Phone 540-200-8821 · Fax 540-779-7889

Mailing address

674 Lees Gap Rd
Fincastle, VA 24090-3869

Phone 540-682-3082

Authorized official

Henry Burgess
Owner
5406823082

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