Healthcare Provider Details

I. General information

NPI: 1023638657
Provider Name (Legal Business Name): MOMENTUM CARE SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 FRANKLIN FARMS DR RM 127
RICHMOND VA
23229-5100
US

IV. Provider business mailing address

PO BOX 226
CARET VA
22436-0226
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-9133
  • Fax: 804-282-9135
Mailing address:
  • Phone: 804-445-5622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TRACY T GERMAINE
Title or Position: AUTHORIZED OFFICIAL / PRESIDENT
Credential: NP
Phone: 804-445-5622