Healthcare Provider Details

I. General information

NPI: 1205249075
Provider Name (Legal Business Name): NMC PORTSMOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 NIDER BLVD STE 100 BRANCH HEALTH CLINIC
LITTLE CREEK VA
23459-8701
US

IV. Provider business mailing address

NAVAL MEDICAL CENTER THIRD PARTY COLLECTIONS 620 JOHN PAUL JONES CIR
PORTHSMOUTH VA
23708-2111
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-8206
  • Fax: 757-953-8217
Mailing address:
  • Phone: 757-953-8206
  • Fax: 757-953-8217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HECTOR MORALES
Title or Position: CHIEF DHA POSC
Credential:
Phone: 210-536-6650