Healthcare Provider Details

I. General information

NPI: 1801824958
Provider Name (Legal Business Name): BMC NORFOLK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRANCH MEDICAL CLINIC 1721 TAUSSIG BLVD
NORFOLK VA
23511
US

IV. Provider business mailing address

9721 7TH BAY ST
NORFOLK VA
23518-1231
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-8739
  • Fax:
Mailing address:
  • Phone: 757-953-8739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1101X
TaxonomyMilitary and U.S. Coast Guard Ambulatory Procedure Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LYNN A GUNKLE
Title or Position: INDEPENDENT DUTY CORPSMAN
Credential: IDC
Phone: 757-953-8739