Healthcare Provider Details

I. General information

NPI: 1982630760
Provider Name (Legal Business Name): NAI SATURN EASTERN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 W WASHINGTON ST
MIDDLEBURG VA
20117
US

IV. Provider business mailing address

250 E PARKCENTER BLVD MAILSTOP SEC2-B
BOISE ID
83706-3940
US

V. Phone/Fax

Practice location:
  • Phone: 540-687-6438
  • Fax: 540-687-5963
Mailing address:
  • Phone: 847-916-4463
  • Fax: 847-916-4736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201003118
License Number StateVA

VIII. Authorized Official

Name: TIFFANY ELIOPULOS
Title or Position: ASSISTANT MANAGER, ENROLLMENTS
Credential:
Phone: 208-395-3906