MEDICARE: ACCREDITED HEALTHCARE CORP

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1578721361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCREDITED HEALTHCARE CORP

Provider Business Mailing Address
First Line	:	4602 WEST GROVE COURT
Second Line	:	SUITE B
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-5414
Country	:	US
Telephone Number	:	757-201-3502
Fax Number	:	757-671-3345

Provider Business Practice Location Address
First Line	:	4602 WESTGROVE CT
Second Line	:	SUITE B
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-5414
Country	:	US
Telephone Number	:	757-201-3502
Fax Number	:	757-671-3345

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. DAVID O ETUTE
Credential	:
Telephone Number	:	757-201-3502

Provider Enumeration Date	:	05/28/2008
Last Update Date	:	12/22/2010

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