Healthcare Provider Details

I. General information

NPI: 1528212412
Provider Name (Legal Business Name): ATLANTIC ELEVATORS OF VIRGINIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2589 QUALITY CT STE 316
VIRGINIA BEACH VA
23454-5324
US

IV. Provider business mailing address

2589 QUALITY CT STE 316
VIRGINIA BEACH VA
23454-5324
US

V. Phone/Fax

Practice location:
  • Phone: 757-749-9532
  • Fax: 757-201-6034
Mailing address:
  • Phone: 757-749-9532
  • Fax: 757-201-6034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateVA

VIII. Authorized Official

Name: MR. EDWARD J. THIBODEAU
Title or Position: MANAGING PARTNER
Credential:
Phone: 757-749-9532