Healthcare Provider Details

I. General information

NPI: 1306202627
Provider Name (Legal Business Name): ALBEMARLE PHYSICIAN SERVICES - SENTARA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 N CROATAN HWY STE 12
KITTY HAWK NC
27949-3990
US

IV. Provider business mailing address

5200 N CROATAN HWY STE 12
KITTY HAWK NC
27949-3990
US

V. Phone/Fax

Practice location:
  • Phone: 252-715-5110
  • Fax: 844-648-0728
Mailing address:
  • Phone: 252-715-5110
  • Fax: 844-648-0728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNC

VIII. Authorized Official

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