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General NPI Number Information
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NPI Number | 1225802499
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Entity Type | Organization
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Legal Business Name | FIRE AND ICE RECOVERY, LLC
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Dates
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Enumeration Date | 11/08/2023
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 11838 CANON BLVD STE 100
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2592
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Country | US
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Telephone | 757-272-1746
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Fax |
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Provider Business Mailing Address
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Address Line | 11838 CANON BLVD STE 100
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2592
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Country | US
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Telephone | 757-272-1746
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID HANNUM
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Credential |
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Telephone | 757-254-1654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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