Healthcare Provider Details

I. General information

NPI: 1255768958
Provider Name (Legal Business Name): VIRGINIA EM-I MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ARH LANE
LOW MOOR VA
24457
US

IV. Provider business mailing address

18167 US HIGHWAY 19 N
CLEARWATER FL
33764-3528
US

V. Phone/Fax

Practice location:
  • Phone: 540-862-6011
  • Fax: 540-862-6472
Mailing address:
  • Phone: 800-507-8874
  • Fax: 727-536-2896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GREGORY BYRNE
Title or Position: PRESIDENT
Credential: MD
Phone: 770-382-1530