CLEANSLATE MEDICAL GROUP OF VIRGINIA, LLC – NPI #1629549779
Internal Medicine

An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine.

Health Care Provider Taxonomy Code for Internal Medicine

CLEANSLATE MEDICAL GROUP OF VIRGINIA, LLC is a provider located in MECHANICSVILLE, VA. NPPES has assigned the NPI number 1629549779 to CLEANSLATE MEDICAL GROUP OF VIRGINIA, LLC on December 16, 2018. It is a Type-2 NPI, indicating this NPI number is associated with an organization. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 207RA0401X from the Health Care Provider Taxonomy code set, which is classified as Internal Medicine, specializing in Addiction Medicine

The NPI profile was last updated on Jul 03, 2024. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for CLEANSLATE MEDICAL GROUP OF VIRGINIA, LLC below.

NPI Profile for
CLEANSLATE MEDICAL GROUP OF VIRGINIA, LLC

NPI Number
1629549779
Enumeration Date

(more than 7 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
CLEANSLATE MEDICAL GROUP OF VIRGINIA, LLC
Primary location
8220 MEADOWBRIDGE RD STE 310
MECHANICSVILLE, VA 23116-2340
Phone: (804) 417-0120 Fax: (804) 277-3029
1 Other location(s):
15 Century Blvd Ste 307
Nashville, TN 37214-3692
Phone: (615) 425-0220
Mailing address
8 CADILLAC DR STE 180
BRENTWOOD, TN 37027-5393
Phone: (615) 425-0220 Fax:
Organization Subpart
No
Authorized Official
MATTHEW SMOLAREK
CFO
Phone: (412) 999-5188
Updated
Certification Date
Jul 03, 2024

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207RA0401X
- Internal Medicine / Addiction Medicine (Primary)
207R00000X
- Internal Medicine

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.