Healthcare Provider Details

I. General information

NPI: 1114322732
Provider Name (Legal Business Name): SOUTHAMPTON HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 EXECUTIVE DR
HAMPTON VA
23666
US

IV. Provider business mailing address

PO BOX 62816
VIRGINIA BEACH VA
23466
US

V. Phone/Fax

Practice location:
  • Phone: 757-723-0252
  • Fax: 866-837-2972
Mailing address:
  • Phone: 757-723-0252
  • Fax: 866-837-2972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. LES V GRAINGER
Title or Position: DIRECTOR
Credential:
Phone: 757-696-0344