MAYO MEDICAL PRACTICE NPI 1891391843

NPI Information

  • NPI: 1891391843
  • Provider Name: MAYO MEDICAL PRACTICE
  • Classification: Clinical Nurse Specialist - 364SF0001X
  • Specialization: Family Health
  • Entity Type: Organization
  • CLIA Number: 49D2212831
  • Address: 563 SOUTHPARK BLVD
    COLONIAL HEIGHTS, VA
    ZIP 23834
  • Phone: (804) 519-0345

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NPI Details

MAYO MEDICAL PRACTICE is a family health clinical nurse specialist in Colonial Heights, VA. MAYO MEDICAL PRACTICE NPI is 1891391843. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

563 SOUTHPARK BLVD
COLONIAL HEIGHTS, VA
ZIP 23834-610
Phone: (804) 519-0345

The provider's authorized official is Edwan Kibot .
The authorized official title is Owner and has the following contact phone number (804) 519-0345.

The CLIA number assigned to this NPI record is 49D2212831 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/7/2020 and was last updated on 12/29/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1364SF0001XClinical Nurse SpecialistFamily HealthYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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