Provider Demographics
NPI:1649560582
Name:ATHENA MEDICAL LLC
Entity Type:Organization
Organization Name:ATHENA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SHEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-675-2831
Mailing Address - Street 1:711 9TH ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-4501
Mailing Address - Country:US
Mailing Address - Phone:757-675-2831
Mailing Address - Fax:757-428-1539
Practice Address - Street 1:711 9TH ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-4501
Practice Address - Country:US
Practice Address - Phone:757-675-2831
Practice Address - Fax:757-428-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies