MEDICARE: VIRTUE MEDICAL SUPPLY COMPANY,LLC

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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	25299363	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437113297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRTUE MEDICAL SUPPLY COMPANY,LLC

Provider Business Mailing Address
First Line	:	4889 SINCLAIR RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-5433
Country	:	US
Telephone Number	:	614-888-8825
Fax Number	:	614-888-8831

Provider Business Practice Location Address
First Line	:	4889 SINCLAIR RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-5432
Country	:	US
Telephone Number	:	614-888-8825
Fax Number	:	614-888-8831

Authorized Official
Title or Position	:	EXECUTIVE DIRECTIVE
Name	:	MS. SABATHA BEATRICE UMOETTE
Credential	:	DME PROVIDER/SUPPLIE
Telephone Number	:	614-888-8825

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	08/22/2020

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