=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750044095
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANSIBLEHEALTH INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2021
-----------------------------------------------------
Last Update Date | 04/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 249 CENTRAL PARK AVE STE 300-55
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23462-3099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-577-2338
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 249 CENTRAL PARK AVE STE 300-55
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23462-3099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. MING JACK PO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 877-267-4253
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------