MEDICARE: INTRUST HEALTH CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	06L21742	VA

General Provider Information

NPI Number	:	1124117148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTRUST HEALTH CARE

Provider Business Mailing Address
First Line	:	19050 FULLER HEIGHTS RD
Second Line	:	APT 312
City	:	TRIANGLE
State	:	VA
Zip	:	22172-2100
Country	:	US
Telephone Number	:	850-345-8724
Fax Number	:

Provider Business Practice Location Address
First Line	:	19050 FULLER HEIGHTS RD
Second Line	:	APT 312
City	:	TRIANGLE
State	:	VA
Zip	:	22172-2100
Country	:	US
Telephone Number	:	850-345-8724
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ADLER ETIENNE
Credential	:
Telephone Number	:	866-219-9773

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	08/22/2020

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