=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861310856
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIRELIX LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2026
-----------------------------------------------------
Last Update Date | 07/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 815 W 180TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10033-3545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 725-223-0698
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 N GOULD ST # 65622
-----------------------------------------------------
City | SHERIDAN
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82801-6317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 725-223-0698
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | SAM JAYSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 725-223-0698
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BD1200X
-----------------------------------------------------
Taxonomy Name | Dialysis Equipment & Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------