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General NPI Number Information
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NPI Number | 1558935809
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Entity Type | Organization
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Legal Business Name | OUT OF THE BOX MEDICAL, LLC
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 3076 GENERAL PULLER HIGHWAY
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City | SALUDA
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State | VA
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Zip | 23149-2314
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Country | US
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Telephone | 804-286-9011
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Fax | 804-286-9275
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Provider Business Mailing Address
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Address Line | PO BOX 1233
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City | SALUDA
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State | VA
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Zip | 23149-1233
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Country | US
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Telephone | 804-286-9011
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Fax | 804-286-9275
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Authorized Official
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Title or Position | OWNER
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Name | DR. CARLA LYNETTE KING
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Credential | MD
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Telephone | 804-286-9011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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