Healthcare Provider Details

I. General information

NPI: 1275725830
Provider Name (Legal Business Name): RGM MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 POPLAR AVE
NEWPORT NEWS VA
23607-5530
US

IV. Provider business mailing address

727 25TH ST
NEWPORT NEWS VA
23607-4601
US

V. Phone/Fax

Practice location:
  • Phone: 757-376-5865
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberA60302387
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: WILLIE ANTHONY BROWN
Title or Position: OWNER
Credential:
Phone: 757-376-5865