Provider Demographics
NPI:1558049429
Name:ETHOS HOUSE CALLS PRACTICE
Entity Type:Organization
Organization Name:ETHOS HOUSE CALLS PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:757-719-0621
Mailing Address - Street 1:7337 OLD CAMP RD
Mailing Address - Street 2:
Mailing Address - City:LANEXA
Mailing Address - State:VA
Mailing Address - Zip Code:23089-5133
Mailing Address - Country:US
Mailing Address - Phone:757-719-0621
Mailing Address - Fax:
Practice Address - Street 1:7337 OLD CAMP RD
Practice Address - Street 2:
Practice Address - City:LANEXA
Practice Address - State:VA
Practice Address - Zip Code:23089-5133
Practice Address - Country:US
Practice Address - Phone:757-719-0621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care