Provider Demographics
NPI:1982617775
Name:VIRGINIA MEDICAL AND RESPIRATORY EQUIPMENT, INC.
Entity Type:Organization
Organization Name:VIRGINIA MEDICAL AND RESPIRATORY EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-935-8621
Mailing Address - Street 1:PO BOX 1380
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614-1380
Mailing Address - Country:US
Mailing Address - Phone:276-935-8621
Mailing Address - Fax:276-935-6111
Practice Address - Street 1:RT 460 RIVERSIDE DRIVE
Practice Address - Street 2:ROYAL CITY SECTION
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614
Practice Address - Country:US
Practice Address - Phone:276-935-8621
Practice Address - Fax:276-935-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206009032332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1351259OtherUMWA
WV3810001882Medicaid
KY90022666Medicaid
VA322964OtherANTHEM BC/BS OF VA
KYS300OtherKY BC/BS
WV3810001882Medicaid