Healthcare Provider Details

I. General information

NPI: 1982363750
Provider Name (Legal Business Name): FLEXCARE MED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 FORT CHISWELL RD STE D
MAX MEADOWS VA
24360-3987
US

IV. Provider business mailing address

245 FORT CHISWELL RD STE D
MAX MEADOWS VA
24360-3987
US

V. Phone/Fax

Practice location:
  • Phone: 276-764-2273
  • Fax: 276-764-2276
Mailing address:
  • Phone: 276-764-2273
  • Fax: 276-764-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANDI NICHOLE MOORE
Title or Position: OWNER, AUTHORIZED OFFICIAL
Credential: PA-C
Phone: 276-764-2273