Provider Demographics
NPI:1033295092
Name:TEAM NURSE, INC
Entity Type:Organization
Organization Name:TEAM NURSE, INC
Other - Org Name:TEAM NURSE STUART
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MIZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-575-5200
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-0776
Mailing Address - Country:US
Mailing Address - Phone:434-575-5200
Mailing Address - Fax:434-575-5204
Practice Address - Street 1:126 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171
Practice Address - Country:US
Practice Address - Phone:276-694-4406
Practice Address - Fax:276-694-4727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WC2100X, 251B00000X, 3747P1801X, 385H00000X
VAHCO-10289251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No163WC2100XNursing Service ProvidersRegistered NurseContinence CareGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1033295092OtherPRIVATE DUTY
VA289OtherVA STATE LICENSE
VA010128790OtherMEDICAID PRIVATE DUTY NURSING
VA010090105Medicaid
VA1033295092OtherPRIVATE DUTY
VA0100901054Medicaid
VA0100768974Medicaid