Healthcare Provider Details

I. General information

NPI: 1285902890
Provider Name (Legal Business Name): INTRAVENE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 LANDOVER PL
LYNCHBURG VA
24501-2115
US

IV. Provider business mailing address

2215 LANDOVER PL
LYNCHBURG VA
24501-2115
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-3900
  • Fax:
Mailing address:
  • Phone: 434-947-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0201002819
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROBERT BRENNAN
Title or Position: PRESIDENT
Credential: MD
Phone: 434-947-3944