1669556387 NPI number — TEAM NURSE, INC.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669556387 NPI number — TEAM NURSE, INC.

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 Other Organization Name:

CARE ADVANTAGE

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:

1669556387

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

03/08/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

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 First Line Business Practice Location Address:

22634 TIMBERLAKE RD

Provider Second Line Business Practice Location Address:

SUITE E

Provider Business Practice Location Address City Name:

LYNCHBURG

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

24502-7311

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

434-582-4755

Provider Business Practice Location Address Fax Number:

434-582-4546

Provider Enumeration Date:

10/25/2006

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

• 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-10295 , registered in the state of VA ; 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" .
• Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 010129010 . This is a "MEDICAID PRIVATE DUTY NURSING" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: HCO-09295 . This is a "STATE LICENSURE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 010129397 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0101293972 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0101162441 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1669556381 . This is a "PRIVATE DUTY" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 010116244 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".