Provider Demographics
NPI:1548416985
Name:HEALTHSMARTVACCINES, LLC
Entity Type:Organization
Organization Name:HEALTHSMARTVACCINES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-961-0734
Mailing Address - Street 1:4437 BROOKFIELD CORPORATE DR
Mailing Address - Street 2:#203
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2122
Mailing Address - Country:US
Mailing Address - Phone:703-961-0734
Mailing Address - Fax:703-961-0732
Practice Address - Street 1:4437 BROOKFIELD CORPORATE DR
Practice Address - Street 2:#203
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2122
Practice Address - Country:US
Practice Address - Phone:703-961-0734
Practice Address - Fax:703-961-0732
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN PEDIATRIC CONSULTANTS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0215000247261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center