MEDICARE: VIRTUOUS HEALTH SERVICES, 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	291U00000X	Clinical Medical Laboratory
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1326568650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRTUOUS HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	3901 ARLINGTON HIGHLANDS BLVD STE 200
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-6050
Country	:	US
Telephone Number	:	817-405-6274
Fax Number	:	817-779-7445

Provider Business Practice Location Address
First Line	:	3901 ARLINGTON HIGHLANDS BLVD STE 247
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-6036
Country	:	US
Telephone Number	:	817-405-6274
Fax Number	:	817-779-7445

Authorized Official
Title or Position	:	CEO
Name	:	ENGGA MICKENS
Credential	:
Telephone Number	:	817-405-6274

Provider Enumeration Date	:	06/27/2017
Last Update Date	:	05/27/2022

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