Healthcare Provider Details

I. General information

NPI: 1689766404
Provider Name (Legal Business Name): SOUTHAMPTON HEALTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 EXECUTIVE DR
HAMPTON VA
23666-2499
US

IV. Provider business mailing address

PO BOX 7470
HAMPTON VA
23666-0470
US

V. Phone/Fax

Practice location:
  • Phone: 757-825-6243
  • Fax: 757-825-6247
Mailing address:
  • Phone: 757-825-6243
  • Fax: 757-825-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY V SMITH
Title or Position: CEO
Credential:
Phone: 757-566-0761