1255419164 NPI number — TEAM NURSE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255419164 NPI number — TEAM NURSE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEAM NURSE, 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:
Provider Other Organization Name Type Code:
6
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:
1255419164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2023
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:
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:
434-575-5204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1372 W GRETNA RD
Provider Second Line Business Practice Location Address:
SUITE B
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:
434-656-6070
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROYSTER
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
SR ACCOUNTING MANAGER
Authorized Official Telephone Number:
804-323-9464

Provider Taxonomy Codes

  • Taxonomy code: 163WC2100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: HCO-10205 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1255419164 . This is a "PRIVATE DUTY" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 008751072 . This is a "MEDICAID PRIVATE DUTY NURSING" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0087735723 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HCO-09205 . This is a "STATE LICENSURE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0087046436 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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