Gladeview Medical LLC
Organization Active NPI Primary Care Clinic/Center · Fries, VA
NPI 1962022392 · NPPES record last updated Apr 27, 2020
Key facts
- NPI
- 1962022392
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- GLADEVIEW MEDICAL LLC
- Practice address
- 279 Gladeview Dr
Fries, VA 24330-3936 - Phone
- (276) 233-7864
- NPI assigned
- Apr 27, 2020
- Organization subpart
- No
Authorized official
- Name
- Heather Richardson, FNP-BC
- Title
- Family Nurse Practitioner/Owner
- Phone
- (276) 233-7864
Practitioners 1
-
Heather Richardson, FNP-BC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D2187127 | Gladeview Medical LLC | Certificate of waiver | Jun 24, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200626000620 | VA | Part B Supplier - Clinic/Group Practice | 4183046790 |
Receives reassigned benefits from 1 practitioner Practice locations: Fries, VA |
National Provider Directory
Locations
279 Gladeview Dr
Fries, VA 24330
Phone (276) 233-7864
Interoperability endpoints
- https://api.platform.athenahealth.com/21642/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
279 Gladeview Dr
Fries, VA 24330-3936
Mailing address
279 Gladeview Dr
Fries, VA 24330-3936
Phone (276) 233-7864
Other providers in Fries, VA
- Fries Community Health Care Inc
- Fries Community Health Care Inc
- Fries Family Care Center PC
- Fries Family Care Center PC
- Fries Volunteer Fire Department Inc
- Roxanne Leigh Gravley
- Angela Jones
- Lifeguard,Personal Emergency Response Systems, LLC
- Casey Elizabeth Peebles
- Heather Richardson
All providers in Fries, VA · Primary Care Clinic/Center in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 27, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.