Provider Demographics
NPI:1053340281
Name:ACADEMIC PRIMARY CARE ASSOCIATES
Entity type:Organization
Organization Name:ACADEMIC PRIMARY CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-232-8405
Mailing Address - Street 1:1691 INNOVATION DR STE 2100
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6618
Mailing Address - Country:US
Mailing Address - Phone:540-232-8405
Mailing Address - Fax:540-232-8429
Practice Address - Street 1:1691 INNOVATION DR STE 2100
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6828
Practice Address - Country:US
Practice Address - Phone:540-232-8405
Practice Address - Fax:540-232-8429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA204D00000X, 207QG0300X, 207V00000X, 208D00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1053340281Medicaid
VADG6086OtherRAILROAD MEDICARE
VA=========OtherTAX ID
VA=========OtherTRICARE
VADG6086OtherRAILROAD MEDICARE