MEDICARE: TEAM NURSE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385H00000X	Respite Care
2	163WC2100X	Continence Care Registered Nurse
3	251B00000X	Case Management Agency
4	251E00000X	Home Health Agency	HCO-0992	VA
5	3747P1801X	Personal Care Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	HCO-0992	OTHER	VA	STATE LICENSURE
4	ML-171464	OTHER	VA	COMMONWEALTH OF VIRGINIA VDH
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174608889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEAM NURSE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 776
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-0776
Country	:	US
Telephone Number	:	434-575-5200
Fax Number	:	434-575-5204

Provider Business Practice Location Address
First Line	:	3352 HALIFAX RD
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-4842
Country	:	US
Telephone Number	:	434-517-0050
Fax Number	:	434-517-0049

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	03/08/2023

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Directions to “TEAM NURSE, INC. ” Practice Location

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