Healthcare Provider Details

I. General information

NPI: 1174147193
Provider Name (Legal Business Name): VIRTU30 TELEHEALTH SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6436 S JOHN BUTLER RD
COLUMBUS IN
47201-9437
US

IV. Provider business mailing address

1540 16TH ST NE
NAPLES FL
34120-3447
US

V. Phone/Fax

Practice location:
  • Phone: 877-298-2079
  • Fax:
Mailing address:
  • Phone: 317-697-9296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERIN CHRISTINE CARR
Title or Position: PRESIDENT
Credential: FNP
Phone: 317-697-9296