Healthcare Provider Details

I. General information

NPI: 1689928004
Provider Name (Legal Business Name): ILS MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3612 PRUDEN BLVD STE B
SUFFOLK VA
23434-7204
US

IV. Provider business mailing address

2085 LYNNHAVEN PKWY STE 106-253
VIRGINIA BEACH VA
23456-1497
US

V. Phone/Fax

Practice location:
  • Phone: 877-571-1821
  • Fax:
Mailing address:
  • Phone: 877-581-1821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateVA

VIII. Authorized Official

Name: BRIAN G MOSS SR.
Title or Position: DIRECTOR OF ADMIN SERVICES
Credential:
Phone: 877-581-1821