Healthcare Provider Details

I. General information

NPI: 1073813317
Provider Name (Legal Business Name): ALBEMARLE PHYSICIAN SERVICES - SENTARA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL DR
ELIZABETH CITY NC
27909-3361
US

IV. Provider business mailing address

100 MEDICAL DR
ELIZABETH CITY NC
27909-3361
US

V. Phone/Fax

Practice location:
  • Phone: 252-384-2600
  • Fax: 252-335-2731
Mailing address:
  • Phone: 252-384-2600
  • Fax: 252-335-2731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9300298
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNC

VIII. Authorized Official

Name: CINDY A TAYLOR
Title or Position: MANAGER
Credential:
Phone: 757-252-2765