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General NPI Number Information
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NPI Number | 1689474553
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Entity Type | Organization
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Legal Business Name | BEYOND VENACARE SERVICES LLC
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 405 S SUMMIT ST STE A
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City | CRESCENT CITY
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State | FL
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Zip | 32112-3048
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Country | US
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Telephone | 386-559-4086
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 366
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City | CRESCENT CITY
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State | FL
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Zip | 32112-0366
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Country | US
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Telephone | 386-559-4086
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Fax | 386-698-4675
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Authorized Official
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Title or Position | CO-OWNER/DIRECTOR
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Name | SYLVIA JAIMES
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Credential |
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Telephone | 386-559-4086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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