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NPI Code Detail

MEDICARE: TIDEWATER ORTHOPAEDIC ASSOCIATES INC

MEDICARE: TIDEWATER ORTHOPAEDIC ASSOCIATES INC
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
1207X00000XOrthopaedic Surgery Physician
2332B00000XDurable Medical Equipment & Medical Supplies
3174400000XSpecialist

General Provider Information

NPI Number : 1629629340
Entity Type Code : Organization
Provider Name (Legal Business Name) : TIDEWATER ORTHOPAEDIC ASSOCIATES INC
Provider Business Mailing Address
First Line : 901 ENTERPRISE PKWY STE 900
Second Line :
City : HAMPTON
State : VA
Zip : 23666-6250
Country : US
Telephone Number : 757-827-2480
Fax Number : 757-299-9917
Provider Business Practice Location Address
First Line : 7007 HARBOUR VIEW BLVD STE 108
Second Line :
City : SUFFOLK
State : VA
Zip : 23435-3657
Country : US
Telephone Number : 757-827-2480
Fax Number : 757-827-2566
Authorized Official
Title or Position : CEO
Name : STACEY TANNER BELL
Credential :
Telephone Number : 757-827-2480
Provider Enumeration Date : 09/24/2019
Last Update Date : 04/05/2024

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Directions to “TIDEWATER ORTHOPAEDIC ASSOCIATES INC ” Practice Location

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