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General NPI Number Information
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NPI Number | 1225058548
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Entity Type | Organization
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Legal Business Name | TIDEWATER ORTHOPAEDIC ASSOCIATES INC
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 03/22/2024
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Provider Practice Location Address
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Address Line | 901 ENTERPRISE PKWY STE 900
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City | HAMPTON
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State | VA
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Zip | 23666-6250
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Country | US
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Telephone | 757-827-2480
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Fax | 757-827-2566
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Provider Business Mailing Address
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Address Line | 901 ENTERPRISE PARKWAY SUITE 900
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City | HAMPTON
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State | VA
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Zip | 23666
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Country | US
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Telephone | 757-827-2480
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Fax | 757-282-5848
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Authorized Official
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Title or Position | CEO
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Name | STACEY TANNER BELL
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Credential |
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Telephone | 757-827-2480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 78013
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License Number State | VA
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