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General NPI Number Information
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NPI Number | 1750921011
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Entity Type | Organization
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Legal Business Name | AMERITA SOUTH ATLANTIC LLC
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Dates
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Enumeration Date | 01/14/2020
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 2331 SEMINOLE LN STE 103
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-8319
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Country | US
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Telephone | 540-932-3000
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Fax | 833-994-0850
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Provider Business Mailing Address
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Address Line | 6912 S QUENTIN ST SUITE 50
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City | CENTENNIAL
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State | CO
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Zip | 80112
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Country | US
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Telephone | 720-282-5325
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Fax | 877-676-0493
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Authorized Official
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Title or Position | CFO
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Name | ALEX KATEN
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Credential |
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Telephone | 720-282-2377
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 335G00000X
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Taxonomy Name | Medical Foods Supplier
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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