Healthcare Provider Details

I. General information

NPI: 1487771051
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 J CLYDE MORRIS BLVD
NEWPORT NEWS VA
23601-1538
US

IV. Provider business mailing address

747 J CLYDE MORRIS BLVD
NEWPORT NEWS VA
23601-1538
US

V. Phone/Fax

Practice location:
  • Phone: 757-736-3680
  • Fax: 757-599-0215
Mailing address:
  • Phone: 757-736-3680
  • Fax: 757-599-0215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. CINDY A TAYLOR
Title or Position: MANAGER
Credential:
Phone: 757-252-3344