1891769840 NPI number — NAVAL MEDICAL CENTER PORTSMOUTH

Table of content: (NPI 1891769840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891769840 NPI number — NAVAL MEDICAL CENTER PORTSMOUTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAVAL MEDICAL CENTER PORTSMOUTH
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:
1891769840
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3127 HARVESTTIME CRES
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23321-5901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-484-0268
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NAVAL MEDICAL CENTER POSRTSMOUTH
Provider Second Line Business Practice Location Address:
620 JOHN PAUL JONES CIR
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23708-2197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-953-7297
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LECLAIR
Authorized Official First Name:
LAWERANCE
Authorized Official Middle Name:
Authorized Official Title or Position:
RADIOLOGY DEPARTMENT HEAD
Authorized Official Telephone Number:
757-953-1128

Provider Taxonomy Codes

  • Taxonomy code: 286500000X , with the licence number:  37611 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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