1093262487 NPI number — TEAM NURSE II, INC.

Table of content: (NPI 1093262487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093262487 NPI number — TEAM NURSE II, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEAM NURSE II, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TEAM NURSE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093262487
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776
Provider Second Line Business Mailing Address:
606 BROAD STREET
Provider Business Mailing Address City Name:
SOUTH BOSTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24592-0776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-575-5200
Provider Business Mailing Address Fax Number:
434-575-5054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1372 W GRETNA RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRETNA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24557-2472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-656-6000
Provider Business Practice Location Address Fax Number:
434-656-1213
Provider Enumeration Date:
09/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GLYNN
Authorized Official First Name:
CHRISTY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF OPERATIONS
Authorized Official Telephone Number:
434-575-5200

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 49D2142019 . This is a "CLIA CLINICAL LABORATORY IMPROVEMENT ADMENMENTS CMS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: HCO0205 . This is a "OLC VIRGINIA DEPT OF HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 497757 . This is a "CCN/PTAN MEDICARE #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 65092 . This is a "ACHC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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