Healthcare Provider Details

I. General information

NPI: 1851469241
Provider Name (Legal Business Name): NAVAL MEDICAL CENTER PORTSMOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

IV. Provider business mailing address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-4271
  • Fax: 757-953-9708
Mailing address:
  • Phone: 757-953-4271
  • Fax: 757-953-9708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number3141832
License Number StateFL

VIII. Authorized Official

Name: MS. EDNA E. MOORE
Title or Position: STAFF WHNP
Credential: N.P.
Phone: 757-953-4271