Healthcare Provider Details

I. General information

NPI: 1801385521
Provider Name (Legal Business Name): VIRTUAL INPATIENT PSYCHIATRY PHYSICIANS BEHAVIORAL NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W PLYMOUTH AVE
DELAND FL
32720-3236
US

IV. Provider business mailing address

PO BOX 7977
CAROL STREAM IL
60197-7977
US

V. Phone/Fax

Practice location:
  • Phone: 844-291-4535
  • Fax:
Mailing address:
  • Phone: 844-291-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN NICHOLS
Title or Position: SVP OF REVENUE OPERATIONS
Credential:
Phone: 615-334-5078