1255419164 NPI number — TEAM NURSE, INC.

Table of content: (NPI 1255419164)

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: 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" .

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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