NPIMap

Organization Active NPI

Olivet Medical Ministry

  • Primary Care Clinic/Center
  • Yorktown, VA
National Provider Identifier
1699082446
Registry record updated Aug 31, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
0024164154 Issued in VA
Legal business name
OLIVET MEDICAL MINISTRY
Practice address
1620 Old Williamsburg Rd
Yorktown, VA 23690-3910
Phone
(757) 886-0608
Fax
(757) 369-3821
NPI assigned
Aug 31, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2010

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

Authorized official

Name
Mr. Robert Bradley Jr., SOCIAL WORKER
Title
Executive Director
Phone
(757) 886-0608

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 0024164154 VA Primary

Addresses

Primary practice location

1620 Old Williamsburg Rd
Yorktown, VA 23690-3910

Mailing address

1620 Old Williamsburg Rd
Yorktown, VA 23690-3910
Phone (757) 886-0608

Other names 1

  • Lackey Free Family Medicine Clinic Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1283212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283212800000",
    "number": "1699082446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 OLD WILLIAMSBURG RD",
            "city": "YORKTOWN",
            "state": "VA",
            "postal_code": "236903910",
            "telephone_number": "757-886-0608",
            "fax_number": "757-369-3821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 OLD WILLIAMSBURG RD",
            "city": "YORKTOWN",
            "state": "VA",
            "postal_code": "236903910",
            "telephone_number": "757-886-0608",
            "fax_number": "757-369-3821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVET MEDICAL MINISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-31",
        "last_updated": "2010-08-31",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "757-886-0608",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "SOCIAL WORKER"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "VA",
            "license": "0024164154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lackey Free Family Medicine Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Yorktown, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2010; 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.