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NPI Code Detail

MEDICARE: OLD DOMINION MEDICAL STAFFING AGENCY LLC

MEDICARE: OLD DOMINION MEDICAL STAFFING AGENCY 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
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1568603033
Entity Type Code : Organization
Provider Name (Legal Business Name) : OLD DOMINION MEDICAL STAFFING AGENCY LLC
Provider Business Mailing Address
First Line : PO BOX 3416
Second Line :
City : RICHMOND
State : VA
Zip : 23235-7416
Country : US
Telephone Number :
Fax Number : 804-716-1931
Provider Business Practice Location Address
First Line : 8541 ELM RD
Second Line :
City : RICHMOND
State : VA
Zip : 23235-1419
Country : US
Telephone Number : 804-303-0712
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF OPERATIONS
Name : MRS. TANISHA BROWN
Credential :
Telephone Number : 804-334-2418
Provider Enumeration Date : 03/13/2009
Last Update Date : 03/13/2009

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Directions to “OLD DOMINION MEDICAL STAFFING AGENCY LLC ” Practice Location

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