Provider Demographics
NPI:1295068500
Name:CRITICAL CARE SYSTEMS INC.
Entity type:Organization
Organization Name:CRITICAL CARE SYSTEMS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:B
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-385-3688
Mailing Address - Street 1:527 BRANCHWAY RD STE B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3088
Mailing Address - Country:US
Mailing Address - Phone:804-378-8005
Mailing Address - Fax:804-378-8009
Practice Address - Street 1:527 BRANCHWAY RD STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-3088
Practice Address - Country:US
Practice Address - Phone:804-378-8005
Practice Address - Fax:804-378-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201004011261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010150965Medicaid
VA0461840042Medicare NSC