=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457662504
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FORT NORFOLK PLAZA URGENT CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2010
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 RIVERVIEW AVE STE 502
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23510-1065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-333-0284
-----------------------------------------------------
Fax | 757-743-1974
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 RIVERVIEW AVE STE 502
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23510-1065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-333-0284
-----------------------------------------------------
Fax | 757-743-1974
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KEITH H NEWBY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 757-333-0284
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------