Provider Demographics
NPI:1750921011
Name:AMERITA SOUTH ATLANTIC LLC
Entity type:Organization
Organization Name:AMERITA SOUTH ATLANTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:KATEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-282-2377
Mailing Address - Street 1:6912 S QUENTIN ST SUITE 50
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112
Mailing Address - Country:US
Mailing Address - Phone:720-282-5325
Mailing Address - Fax:877-676-0493
Practice Address - Street 1:2331 SEMINOLE LN STE 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8319
Practice Address - Country:US
Practice Address - Phone:540-932-3000
Practice Address - Fax:833-994-0850
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERITA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-14
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335G00000XSuppliersMedical Foods Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VANCPDPOther4850942