MEDICARE: DELOATCH ENTERPRISE INC.

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	1202007654

General Provider Information

NPI Number	:	1730433046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELOATCH ENTERPRISE INC.

Provider Business Mailing Address
First Line	:	325 B FIRST COLONIAL ROAD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-4665
Country	:	US
Telephone Number	:	757-498-8199
Fax Number	:	757-437-0626

Provider Business Practice Location Address
First Line	:	325 B FIRST COLONIAL ROAD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-4665
Country	:	US
Telephone Number	:	757-498-8199
Fax Number	:	757-437-0626

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. LINDA K DELOATCH
Credential	:
Telephone Number	:	757-498-8199

Provider Enumeration Date	:	11/08/2012
Last Update Date	:	11/08/2012

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Directions to “DELOATCH ENTERPRISE INC. ” Practice Location

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