PROVIDENCE FAMILY & SPORTS MEDICINE, INC - NPI 1053403378

Q: What is the provider's specialty?

The provider's specialty is Family Medicine with taxonomy code 207Q00000X.

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About Providence Family & Sports Medicine, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE FAMILY & SPORTS MEDICINE, INC (NPI 1053403378) is a healthcare organization registered as a family medicine in Danville, Virginia and active in the NPI registry since September 2006. The organization holds a CLIA Microscopy certificate valid through June 15, 2027, maintains a secondary practice location in Danville, and lists Lisa Campbell Wood, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1053403378

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NamePROVIDENCE FAMILY & SPORTS MEDICINE, INC

Location Address173 EXECUTIVE DRDanville, VA 24541-4101

Mailing Address173 Executive DrDanville, VA 24541-4101 · (434) 791-4110 · Fax (434) 791-4003

Phone(434) 791-4110

Fax(434) 791-4003

Organization SubpartNo

Authorized OfficialLisa Campbell WoodOffice Manager · (434) 791-4110

Enumeration DateSeptember 28, 2006

Last NPPES UpdateMay 26, 2022

NPPES CertifiedMay 26, 2022

✔ NPI 1053403378 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

173 EXECUTIVE DR, Danville, VA 24541

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Secondary Practice Location 1

Location 1441 Piney Forest Rd, SUITE EDanville, VA 24540-4154 · Phone (434) 791-4110 · Fax (434) 791-4003

Other Identifiers 1

Other1053403378Npi

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 49D0961761

Providence Family And Sports Medicine · Danville, VA

Active · expires Jun 15, 2027

CLIA Number49D0961761

Laboratory TypePhysician Office

Certificate Effective DateJune 16, 2025

Certificate Expiration DateJune 15, 2027

Laboratory DirectorAlbert C. Winfield, II, MD

Laboratory Phone(434) 791-4110

Laboratory LocationProvidence Family And Sports Medicine173 Executive Drive, Danville, VA 24541

CLIA data matches this NPI record on: Address Phone

This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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