Provider Demographics
NPI:1710653548
Name:VIRTUE MEDICAL PA, PLLC
Entity Type:Organization
Organization Name:VIRTUE MEDICAL PA, PLLC
Other - Org Name:VIRTUE MEDICAL PA, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DANI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:806-382-5064
Mailing Address - Street 1:PO BOX 1500
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426-1500
Mailing Address - Country:US
Mailing Address - Phone:940-255-6552
Mailing Address - Fax:940-202-7058
Practice Address - Street 1:401 CENTER COURT DR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2250
Practice Address - Country:US
Practice Address - Phone:940-255-6552
Practice Address - Fax:940-202-7058
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRTUE MEDICAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-20
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty