Healthcare Provider Details

I. General information

NPI: 1174693592
Provider Name (Legal Business Name): SENTARA ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 INDEPENDENCE PKWY SUITE 300
CHESAPEAKE VA
23320-5176
US

IV. Provider business mailing address

535 INDEPENDENCE PKWY SUITE 300
CHESAPEAKE VA
23320-5176
US

V. Phone/Fax

Practice location:
  • Phone: 757-382-4980
  • Fax: 787-382-4957
Mailing address:
  • Phone: 757-553-3000
  • Fax: 787-382-4957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number0201003309
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: KIM BRADLEY
Title or Position: VICE PRESIDENT, SENTARA ENTERPRISES
Credential:
Phone: 757-553-3000