Chase City Primary Care Center, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CHASE CITY PRIMARY CARE CENTER, LLC

Practice address

200 E 5TH St
Chase City, VA 23924-1456

Phone

(434) 372-0900

Fax

(434) 372-8681

NPI assigned

May 22, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Ronnie Tatum Jr.

Title

VP of Finance/Cfo

Phone

(434) 774-2400

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223337600000",
    "number": "1790739761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E 5TH ST",
            "city": "CHASE CITY",
            "state": "VA",
            "postal_code": "239241456",
            "telephone_number": "434-372-0900",
            "fax_number": "434-372-8681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E 5TH ST",
            "city": "CHASE CITY",
            "state": "VA",
            "postal_code": "239241456",
            "telephone_number": "434-372-0900",
            "fax_number": "434-372-8681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHASE CITY PRIMARY CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2008-10-07",
        "status": "A",
        "authorized_official_last_name": "TATUM",
        "authorized_official_first_name": "RONNIE",
        "authorized_official_title_or_position": "VP OF FINANCE/CFO",
        "authorized_official_telephone_number": "434-774-2400",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC MEDICAID #",
            "identifier": "5903162",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Consuelo Boyd
• Treya Zion Browning, D.O.
• Eileen Frances Centuolo, OTRL
• Chase City Health Care LLC
• Chase City Primary Care Center, LLC
• Chase City Rescue Squad, Inc.
• Joyce J Cheenath
• Stefanie Cramer, DPT
• Brittney Angel Crews, LPTA
• Amy Katherine Daniels, DNP, AGNP

• All providers in Chase City, VA
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2008; 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.