Healthcare Provider Details

I. General information

NPI: 1518676121
Provider Name (Legal Business Name): JEFF KATRA MEDICAL SERVICES. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 11/22/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 BERKMAR CIR
CHARLOTTESVILLE VA
22901-1464
US

IV. Provider business mailing address

PO BOX 8041
CHARLOTTESVILLE VA
22906-8041
US

V. Phone/Fax

Practice location:
  • Phone: 434-400-9668
  • Fax: 434-465-6018
Mailing address:
  • Phone: 804-282-9133
  • Fax: 804-282-9135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFF JASON KATRA
Title or Position: SOLE MEMBER OWNER
Credential: DO
Phone: 570-690-4186