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
State | License ID | Taxonomies |
---|---|---|
VA | 0206009853 | 332B00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies |