Healthcare Provider Details

I. General information

NPI: 1508292301
Provider Name (Legal Business Name): VIRGINA EM-I MEDICAL SERVICES, P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18167 US HIGHWAY 19 N SUITE #650
CLEARWATER FL
33764-3528
US

IV. Provider business mailing address

3700 S MAIN ST
BLACKSBURG VA
24060-7017
US

V. Phone/Fax

Practice location:
  • Phone: 727-437-0818
  • Fax:
Mailing address:
  • Phone: 540-951-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY J BYRNE
Title or Position: PRESIDENT/MD
Credential:
Phone: 800-507-8874