MEDICARE: VIP HEALTHCARE PROFESSIONALS, LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1245300680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIP HEALTHCARE PROFESSIONALS, LLC

Provider Business Mailing Address
First Line	:	2600 WEST BLVD
Second Line	:	COLONIAL SQUARE OFFICE PARK
City	:	BELLEVILLE
State	:	IL
Zip	:	62221-5605
Country	:	US
Telephone Number	:	618-235-2273
Fax Number	:	618-235-2417

Provider Business Practice Location Address
First Line	:	2600 WEST BLVD
Second Line	:	COLONIAL SQUARE OFFICE PARK
City	:	BELLEVILLE
State	:	IL
Zip	:	62221-5605
Country	:	US
Telephone Number	:	618-235-2273
Fax Number	:	618-235-2417

Authorized Official
Title or Position	:	OWNER CEO
Name	:	MRS. VEEDA LAVON MARTIN
Credential	:
Telephone Number	:	618-235-2273

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	04/20/2008

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