Healthcare Provider Details

I. General information

NPI: 1336739010
Provider Name (Legal Business Name): SCOTT KALIS MSHS, NRP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 02/15/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNITED STATES NAVY 1510 GILBERT ST
NORFOLK VA
23511
US

IV. Provider business mailing address

2245 KINDLING HOLLOW RD
VIRGINIA BEACH VA
23456-3849
US

V. Phone/Fax

Practice location:
  • Phone: 757-435-1756
  • Fax:
Mailing address:
  • Phone: 757-418-1472
  • Fax: 757-430-3772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberE031981004
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: