MEDICARE: DISTANCE MEDICAL STAFFING LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	313M00000X	Nursing Facility/Intermediate Care Facility
3	251E00000X	Home Health Agency
4	251G00000X	Community Based Hospice Care Agency
5	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1912705567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISTANCE MEDICAL STAFFING LLC

Provider Business Mailing Address
First Line	:	1806 CHANTILLY ST STE 1
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-3513
Country	:	US
Telephone Number	:	571-300-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1806 CHANTILLY ST STE 1
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-3513
Country	:	US
Telephone Number	:	571-300-4200
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS ASHLEY MEGGIE
Credential	:
Telephone Number	:	571-300-4200

Provider Enumeration Date	:	03/07/2025
Last Update Date	:	03/07/2025

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