Healthcare Provider Details

I. General information

NPI: 1053689299
Provider Name (Legal Business Name): ALBEMARLE PHYSICIAN SERVICES - SENTARA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 N ROAD ST STE 200
ELIZABETH CITY NC
27909-3473
US

IV. Provider business mailing address

1144 N ROAD ST STE 200
ELIZABETH CITY NC
27909-3473
US

V. Phone/Fax

Practice location:
  • Phone: 252-384-2360
  • Fax: 252-384-2359
Mailing address:
  • Phone: 252-384-2360
  • Fax: 252-384-2359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNC

VIII. Authorized Official

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