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General NPI Number Information
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NPI Number | 1164713335
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Entity Type | Organization
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Legal Business Name | VIRTUSMD, INC.
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Dates
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Enumeration Date | 04/22/2011
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Last Update Date | 04/22/2011
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Provider Practice Location Address
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Address Line | 242 LYNBROOK BLVD
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City | SHREVEPORT
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State | LA
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Zip | 71106-6548
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Country | US
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Telephone | 318-869-4555
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Fax | 318-841-4350
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Provider Business Mailing Address
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Address Line | PO BOX 6657
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City | SHREVEPORT
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State | LA
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Zip | 71136-6657
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Country | US
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Telephone | 318-869-4555
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Fax | 318-841-4350
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Authorized Official
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Title or Position | C.O.O.
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Name | WILLIAM BYRD
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Credential |
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Telephone | 318-841-4312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 09-12573
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License Number State | LA
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