Provider Demographics
NPI:1578902730
Name:SPIRE DME LLC
Entity Type:Organization
Organization Name:SPIRE DME LLC
Other - Org Name:SPIRE PHARMACY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCAVOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-980-8116
Mailing Address - Street 1:200 GARRETT ST
Mailing Address - Street 2:SUITE O
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5693
Mailing Address - Country:US
Mailing Address - Phone:434-980-8100
Mailing Address - Fax:
Practice Address - Street 1:750 HARRIS ST
Practice Address - Street 2:SUITE 104-105
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4500
Practice Address - Country:US
Practice Address - Phone:434-980-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206009853332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies