Healthcare Provider Details

I. General information

NPI: 1457891145
Provider Name (Legal Business Name): ULTRA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1039 MAYBERRY CROSSING DR STE A&B
MONETA VA
24121-6413
US

IV. Provider business mailing address

PO BOX 489
POUNDING MILL VA
24637-0489
US

V. Phone/Fax

Practice location:
  • Phone: 540-546-3744
  • Fax:
Mailing address:
  • Phone: 276-385-1183
  • Fax: 276-258-6492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFFERY H TAYLOR
Title or Position: OWNER
Credential:
Phone: 276-971-0783