Healthcare Provider Details

I. General information

NPI: 1760067748
Provider Name (Legal Business Name): VIEMED CLINICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 N TATUM BLVD STE 1250
PHOENIX AZ
85028-1611
US

IV. Provider business mailing address

11801 N TATUM BLVD STE 1250
PHOENIX AZ
85028-1611
US

V. Phone/Fax

Practice location:
  • Phone: 833-452-0220
  • Fax: 800-398-9547
Mailing address:
  • Phone: 833-452-0220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RYAN SULLIVAN
Title or Position: EXECUTIVE VP
Credential:
Phone: 337-504-3802