Provider Demographics
NPI:1689928004
Name:ILS MEDICAL, INC
Entity Type:Organization
Organization Name:ILS MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMIN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:877-581-1821
Mailing Address - Street 1:2085 LYNNHAVEN PKWY STE 106-253
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-1497
Mailing Address - Country:US
Mailing Address - Phone:877-581-1821
Mailing Address - Fax:
Practice Address - Street 1:3612 PRUDEN BLVD STE B
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-7204
Practice Address - Country:US
Practice Address - Phone:877-571-1821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care