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General NPI Number Information
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NPI Number | 1093110223
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Entity Type | Organization
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Legal Business Name | TIDEWATER HEARING CENTER
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 10/31/2014
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Provider Practice Location Address
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Address Line | 5200 MERCURY BLVD SEARS, SUITE 100
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City | NEWPORT NEWS
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State | VA
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Zip | 23605-1445
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Country | US
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Telephone | 757-825-9477
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Fax |
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Provider Business Mailing Address
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Address Line | 2555 COVE POINT PL
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3271
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Country | US
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Telephone | 757-825-9477
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Fax | 757-825-9139
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JANET IVENS
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Credential |
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Telephone | 757-825-9477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 03231
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 14763800005200
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 124122
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License Number State | VA
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