MEDICARE: T.A.G. 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	251S00000X	Community/Behavioral Health Agency	204903001	VA

General Provider Information

NPI Number	:	1851723779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T.A.G. INC.

Provider Business Mailing Address
First Line	:	25801 COX RD
Second Line	:
City	:	NORTH DINWIDDIE
State	:	VA
Zip	:	23803-6517
Country	:	US
Telephone Number	:	804-647-9292
Fax Number	:

Provider Business Practice Location Address
First Line	:	25801 COX RD
Second Line	:
City	:	NORTH DINWIDDIE
State	:	VA
Zip	:	23803-6517
Country	:	US
Telephone Number	:	804-647-9292
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JAQUAN WINSTON
Credential	:
Telephone Number	:	804-647-9292

Provider Enumeration Date	:	08/01/2013
Last Update Date	:	08/01/2013

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