Provider Demographics
NPI:1972919512
Name:VIRTUWELL MEDICAL SERVICES, P.C.
Entity type:Organization
Organization Name:VIRTUWELL MEDICAL SERVICES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PALLATAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-883-5348
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MAIL STOP 21110R
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-7469
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:178 9TH ST E
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2317
Practice Address - Country:US
Practice Address - Phone:877-440-1001
Practice Address - Fax:651-265-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty