Healthcare Provider Details

I. General information

NPI: 1740196872
Provider Name (Legal Business Name): INSPIRE HEALTH IV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7113 ELIZABETH DR
MC LEAN VA
22101-2626
US

IV. Provider business mailing address

7113 ELIZABETH DR
MC LEAN VA
22101-2626
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone: 999-999-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND DOUGLAS
Title or Position: OWNER
Credential: MD
Phone: 999-999-9999