Healthcare Provider Details

I. General information

NPI: 1619303625
Provider Name (Legal Business Name): VIRGINIA EM-I MEDICAL SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 LEE HWY N
PULASKI VA
24301-2326
US

IV. Provider business mailing address

P.O. BOX 37964
PHILADELPHIA PA
19101
US

V. Phone/Fax

Practice location:
  • Phone: 540-994-8100
  • Fax:
Mailing address:
  • Phone: 800-507-8874
  • Fax: 727-536-2896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GREGORY J. BYRNE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 800-507-8874