Provider Demographics
NPI:1457891145
Name:ULTRA HEALTH LLC
Entity Type:Organization
Organization Name:ULTRA HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:H
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-971-0783
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:POUNDING MILL
Mailing Address - State:VA
Mailing Address - Zip Code:24637-0489
Mailing Address - Country:US
Mailing Address - Phone:276-385-1183
Mailing Address - Fax:276-258-6492
Practice Address - Street 1:1039 MAYBERRY CROSSING DR STE A&B
Practice Address - Street 2:
Practice Address - City:MONETA
Practice Address - State:VA
Practice Address - Zip Code:24121-6413
Practice Address - Country:US
Practice Address - Phone:540-546-3744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1457891145Medicaid