Healthcare Provider Details

I. General information

NPI: 1447684337
Provider Name (Legal Business Name): FMP HEALTH CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 INDEPENDENCE BLVD
VIRGINIA BEACH VA
23455-5545
US

IV. Provider business mailing address

1147 INDEPENDENCE BLVD
VIRGINIA BEACH VA
23455-5545
US

V. Phone/Fax

Practice location:
  • Phone: 757-460-1207
  • Fax: 757-460-2136
Mailing address:
  • Phone: 757-460-1207
  • Fax: 757-460-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE A EUBANK
Title or Position: PRESIDENT
Credential: MA, DAPA
Phone: 757-460-1207