Provider Demographics
NPI:1326605940
Name:VIRTUAL PREVENTIVE CARE SERVICES
Entity Type:Organization
Organization Name:VIRTUAL PREVENTIVE CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:VIVIAN
Authorized Official - Last Name:CARTER-GEIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-847-7711
Mailing Address - Street 1:160 LONG LN STE 3
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-3439
Mailing Address - Country:US
Mailing Address - Phone:484-661-2257
Mailing Address - Fax:610-734-0272
Practice Address - Street 1:160 LONG LN STE 3
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-3439
Practice Address - Country:US
Practice Address - Phone:484-661-2257
Practice Address - Fax:610-734-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103494408-0001Medicaid