Basic Information
| Provider Information | |||||||||
| NPI: | 1306103866 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEDICAL DIRECT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7421 CENTRAL BUSINESS PARK DR | ||||||||
| Address2: | SUITE 106 B | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235132800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574802929 | ||||||||
| FaxNumber: | 7574802990 | ||||||||
| Practice Location | |||||||||
| Address1: | 7421 CENTRAL BUSINESS PARK DR | ||||||||
| Address2: | SUITE 106 B | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235132800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574802929 | ||||||||
| FaxNumber: | 7574802990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2012 | ||||||||
| LastUpdateDate: | 04/30/2012 | ||||||||
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| AuthorizedOfficialLastName: | BEDOYA | ||||||||
| AuthorizedOfficialFirstName: | SHERRY | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7574802929 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | REGISTERED NURSE | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251J00000X | Y | Agencies | Nursing Care |
No ID Information.