Healthcare Provider Details

I. General information

NPI: 1427979020
Provider Name (Legal Business Name): JASON LIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2847 BLUEWATER DR
MONETA VA
24121-2766
US

IV. Provider business mailing address

2847 BLUEWATER DR
MONETA VA
24121-2766
US

V. Phone/Fax

Practice location:
  • Phone: 540-580-7761
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberB052602301
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: