Healthcare Provider Details

I. General information

NPI: 1558935809
Provider Name (Legal Business Name): OUT OF THE BOX MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3076 GENERAL PULLER HIGHWAY
SALUDA VA
23149-2314
US

IV. Provider business mailing address

PO BOX 1233
SALUDA VA
23149-1233
US

V. Phone/Fax

Practice location:
  • Phone: 804-286-9011
  • Fax: 804-286-9275
Mailing address:
  • Phone: 804-286-9011
  • Fax: 804-286-9275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLA LYNETTE KING
Title or Position: OWNER
Credential: MD
Phone: 804-286-9011