=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982436713
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RENAISSANCE MEDICAL TRAINING GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2024
-----------------------------------------------------
Last Update Date | 08/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 716 DENBIGH BLVD STE C3
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23608-4414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-809-2240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 716 DENBIGH BLVD STE C3
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23608-4414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-809-2240
-----------------------------------------------------
Fax | 757-540-1022
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER/PROGRAM COORDINATOR
-----------------------------------------------------
Name | MS. TIFFANY EVETTE GRIFFIN
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 757-335-4400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------