MEDICARE: NAI SATURN EASTERN 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	0201003087	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2150026	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477582484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAI SATURN EASTERN LLC

Provider Business Mailing Address
First Line	:	250 E PARKCENTER BLVD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83706-3940
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7900 FORT HUNT RD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22308-1203
Country	:	US
Telephone Number	:	703-765-0540
Fax Number	:	703-660-5986

Authorized Official
Title or Position	:	ENROLLMENTS MANAGER
Name	:	KATHY GIANNAKOPOULOS
Credential	:
Telephone Number	:	208-395-3954

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	06/22/2020

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