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PULASKI MEDICAL, LLC
NPI 1558607481
Clinic/Center - Methadone in Pulaski, VA

Active since December 21, 2012CLIA 49D2123759 · Waiver
1006 E MAIN ST, 1006, PULASKI, VA 24301(540) 980-1125(540) 908-1127 Get Directions Write a Review

NPPES record last updated: November 21, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Nov 21, 2023, Sep 23, 2020, Dec 23, 2019 (3 updates tracked since 2019).

About Pulaski Medical, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PULASKI MEDICAL, LLC (NPI 1558607481) is a healthcare organization registered as a methadone in Pulaski, Virginia and active in the NPI registry since December 2012. The organization holds a CLIA Waiver certificate valid through December 30, 2026 and lists Robyn Tanis, Executive Director Of Contract Mgmt, as its authorized official.

NPPES Registry Identity

NPI1558607481
Entity TypeOrganization
Primary Taxonomy261QM2800X
Legal Business NamePULASKI MEDICAL, LLC
Location Address1006 E MAIN ST, 1006Pulaski, VA 24301-5218
Mailing Address1317 Route 73 Ste 200Mount Laurel, NJ 08054-2202 · (856) 439-6111
Phone(540) 980-1125
Fax(540) 908-1127
Organization SubpartNo
Authorized OfficialRobyn TanisExecutive Director Of Contract Mgmt · (856) 533-8762
Enumeration DateDecember 21, 2012
Last NPPES UpdateNovember 21, 20233 updates tracked since enumeration
NPPES CertifiedNovember 21, 2023
✔ NPI 1558607481 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyClinic/Center · MethadoneAmbulatory Health Care Facilities
Taxonomy Code261QM2800X
Definition

An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

Also ListedCommunity/Behavioral HealthTaxonomy 251S00000X
Also ListedClinic/Center · Recovery CareTaxonomy 261QR0800X
1006 E MAIN ST, Pulaski, VA 24301
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D2123759

Pulaski Medical, LLC · Pulaski, VA
Active · expires Dec 30, 2026
CLIA Number49D2123759
Laboratory TypeOpioid Treatment Program
Certificate Effective DateDecember 31, 2024
Certificate Expiration DateDecember 30, 2026
Laboratory DirectorRay A. Mercado
Laboratory Phone(540) 980-1125
Laboratory LocationPulaski Medical, LLC1006 East Main Street, Pulaski, VA 24301
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatm G2067
Medication Assisted Treatment (MAT) with methadone is a comprehensive approach to manage opioid addiction. It includes weekly methadone dispensing, substance use counseling, individual and group therapy sessions, and toxicology tests as needed, all provided by a Medicare-enrolled opioid treatment program.
878 services39 patients
Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure G2078
This service provides an additional 7-day supply of methadone, a medication used to treat opioid addiction, for patients to take at home. It's provided by a Medicare-enrolled opioid treatment program. This service is billed separately from the main treatment procedure.
393 services24 patients

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

REBECCA WILLIAMS SCOTT FNP-C
Family Medicine (Addiction Medicine)
1006 E MAIN ST
PULASKI, VA 24301
Pulaski County (540) 980-1125
MARTHA ABERA LCSW
Social Worker (Clinical)
1006 E MAIN ST
PULASKI, VA 24301
Pulaski County (540) 980-1125
NEW RIVER VALLEY COMMUNITY SERVICES
Social Worker (Clinical)
1006 E MAIN ST
PULASKI, VA 24301
Pulaski County (540) 994-5023
MRS. CRYSTAL M DAVIS FNP-BC
Nurse Practitioner (Family)
1006 E MAIN ST
PULASKI, VA 24301
Pulaski County (540) 980-1125

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pulaski Medical, LLC's NPI number?

The NPI number for Pulaski Medical, LLC is 1558607481. It was assigned to this organization in the NPPES registry on December 21, 2012.

Where is Pulaski Medical, LLC located?

Pulaski Medical, LLC is located at 1006 E Main St 1006, Pulaski, VA 24301. The listed phone number is (540) 980-1125.

What is Pulaski Medical, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Methadone, with taxonomy code 261QM2800X.

Does Pulaski Medical, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D2123759) is associated with this NPI, valid through December 30, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Pulaski Medical, LLC was last updated on November 21, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.