Pulaski Medical, LLC

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

Legal business name

PULASKI MEDICAL, LLC

Practice address

1006 E Main St
1006
Pulaski, VA 24301-5218

Phone

(540) 980-1125

Fax

(540) 908-1127

NPI assigned

Dec 21, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robyn Tanis

Title

Executive Director of Contract MGMT

Phone

(856) 533-8762

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Opioid treatment program

Medicare-enrolled since Jan 1, 2020

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ray Mercado, DO

  • General Practice Physician
  • Scarsdale, NY
  • NPI 1275606030
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1356048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700524800000",
    "number": "1558607481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 ROUTE 73 STE 200",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080542202",
            "telephone_number": "856-439-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 E MAIN ST",
            "address_2": "1006",
            "city": "PULASKI",
            "state": "VA",
            "postal_code": "243015218",
            "telephone_number": "540-980-1125",
            "fax_number": "540-908-1127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PULASKI MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-21",
        "last_updated": "2023-11-21",
        "certification_date": "2023-11-21",
        "status": "A",
        "authorized_official_last_name": "TANIS",
        "authorized_official_first_name": "ROBYN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR OF CONTRACT MGMT",
        "authorized_official_telephone_number": "856-533-8762"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Recovery Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pulaski Community Hospital, Inc.
• Pulaski County Public Schools
• Pulaski County Public Schools
• Pulaski County Public Schools
• Pulaski County Schools
• Pulaski Operations LLC
• Pulaski Radiologists LLC
• Pulaski Urology LLC
• Pulaski Urology, LLC
• Radiology Services International PC

• Methadone Clinic in Pulaski, VA
• Providers in Pulaski, VA by specialty
• Methadone Clinic in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.