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General NPI Number Information
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NPI Number | 1245214477
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Entity Type | Organization
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Legal Business Name | TIDALHEALTH NANTICOKE, INC
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 801 MIDDLEFORD RD
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City | SEAFORD
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State | DE
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Zip | 19973-3636
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Country | US
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Telephone | 302-629-6611
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Fax | 302-628-6363
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Provider Business Mailing Address
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Address Line | 801 MIDDLEFORD RD
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City | SEAFORD
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State | DE
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Zip | 19973-3636
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Country | US
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Telephone | 302-629-6611
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Fax | 302-628-6363
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Authorized Official
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Title or Position | VICE PRESIDENT-FINANCE/ CFO
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Name | STEPHANIE GARY
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Credential |
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Telephone | 410-912-6059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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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 | 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 #3
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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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 | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | HSPTL008
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License Number State | DE
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