Healthcare Provider's Profile
| Full Name | |
|---|
| Type | Facility |
|---|
| Speciality | Durable Medical Equipment & Medical Supplies - Customized Equipment |
|---|
| Location | 107 Mactanly Pl, Staunton, Virginia |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1174724983
- Provider Enumeration Date: 05/30/2007
- Last Update Date: 07/27/2021
Medical Identifiers
Medical identifiers for
such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1174724983 | NPI | - | NPPES |
| C08501858 | Other | VA | MEDICARE-DME JURS C |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 225XH1200X | Occupational Therapist - Hand | (* (Not Available)) | Secondary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | 0119000943 (Virginia) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | 011900943 (Virginia) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
107 Mactanly Pl,
Staunton, VA 24401-2372
Ph: (540) 885-1177 |
107 Mactanly Pl,
Staunton, VA 24401
Ph: (540) 885-1177 |
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