Healthcare Provider Details

I. General information

NPI: 1518028604
Provider Name (Legal Business Name): INTRAVENE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 10/14/2013
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: 434-544-2332
Mailing address:
  • Phone: 434-947-3900
  • Fax: 434-544-2332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. NANCY DAVIS MOORE
Title or Position: PHARMACIST
Credential:
Phone: 434-947-3900