1588834113 NPI number — TIDEWATER DIAGNOSTIC INTERPRETERS,INC

Table of content: (NPI 1588834113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588834113 NPI number — TIDEWATER DIAGNOSTIC INTERPRETERS,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIDEWATER DIAGNOSTIC INTERPRETERS,INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588834113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5391
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23703-1391
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-238-9401
Provider Business Mailing Address Fax Number:
757-686-8156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2994 CHURCHLAND BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23321-5643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-484-5264
Provider Business Practice Location Address Fax Number:
757-686-8156
Provider Enumeration Date:
03/11/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LANE
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
BASS
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
757-238-9401

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 031305 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: CB8291 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".