Healthcare Provider Details

I. General information

NPI: 1902582802
Provider Name (Legal Business Name): VELTEX MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MARTIN DRIVE
MOUNT HOPE WV
25880
US

IV. Provider business mailing address

123 W MADISON ST STE 1500
CHICAGO IL
60602
US

V. Phone/Fax

Practice location:
  • Phone: 681-422-3338
  • Fax:
Mailing address:
  • Phone: 312-722-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MICAH REEVES
Title or Position: GENERAL COUNSEL
Credential:
Phone: 312-722-0303