CH VA Collaborative Care LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

CH VA COLLABORATIVE CARE LLC

Practice address

4099 Basswood Rd
Disputanta, VA 23842-4517

Phone

(571) 781-7001

Fax

(888) 722-4282

NPI assigned

Sep 5, 2014

Last updated

Feb 10, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Melissa M Cooke

Title

Chief Financial Officer

Phone

(972) 715-3808

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423526400000",
    "number": "1184025439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4055 VALLEY VIEW LN",
            "address_2": "SUITE 400",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752445074",
            "telephone_number": "972-715-3800",
            "fax_number": "888-722-4282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4099 BASSWOOD RD",
            "city": "DISPUTANTA",
            "state": "VA",
            "postal_code": "238424517",
            "telephone_number": "571-781-7001",
            "fax_number": "888-722-4282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CH VA COLLABORATIVE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-05",
        "last_updated": "2015-02-10",
        "status": "A",
        "authorized_official_last_name": "COOKE",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "972-715-3808"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE CERTIFICATION NUMBER",
            "identifier": "E110",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.