MEDICARE: SELFHEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1568282796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELFHEALTH LLC

Provider Business Mailing Address
First Line	:	102 HOLLY CRES
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-3856
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 HOLLY CRES
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-3856
Country	:	US
Telephone Number	:	757-567-0769
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL MEDDOWS
Credential	:	MD
Telephone Number	:	757-567-0769

Provider Enumeration Date	:	10/14/2024
Last Update Date	:	10/14/2024

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Directions to “SELFHEALTH LLC ” Practice Location

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