Provider Demographics
NPI:1710204425
Name:VIRGINIA MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:VIRGINIA MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEIFU
Authorized Official - Middle Name:TESHOME
Authorized Official - Last Name:SERTSE
Authorized Official - Suffix:
Authorized Official - Credentials:MT(ASCP)
Authorized Official - Phone:703-436-1626
Mailing Address - Street 1:3534 CARLIN SPRINGS RD STE 6
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-3095
Mailing Address - Country:US
Mailing Address - Phone:703-436-1626
Mailing Address - Fax:703-635-3299
Practice Address - Street 1:3534 CARLIN SPRINGS RD STE 6
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3095
Practice Address - Country:US
Practice Address - Phone:703-436-1626
Practice Address - Fax:703-635-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAMT-202857291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory