Provider Demographics
NPI:1487613113
Name:THE FAMILY PRACTICE OF MANAKIN-SABOT PC
Entity type:Organization
Organization Name:THE FAMILY PRACTICE OF MANAKIN-SABOT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:HELLAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:804-784-8800
Mailing Address - Street 1:294 RIVER RD W
Mailing Address - Street 2:
Mailing Address - City:MANAKIN SABOT
Mailing Address - State:VA
Mailing Address - Zip Code:23103-3200
Mailing Address - Country:US
Mailing Address - Phone:804-784-8800
Mailing Address - Fax:804-784-7203
Practice Address - Street 1:294 RIVER RD W
Practice Address - Street 2:
Practice Address - City:MANAKIN SABOT
Practice Address - State:VA
Practice Address - Zip Code:23103-3200
Practice Address - Country:US
Practice Address - Phone:804-784-8800
Practice Address - Fax:804-784-7203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C08626OtherMEDICARE GROUP NUMBER