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General NPI Number Information
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NPI Number | 1871311159
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Entity Type | Organization
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Legal Business Name | CLUBMDNOW
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Dates
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Enumeration Date | 09/26/2024
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 941 BOBOLINK DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-4945
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Country | US
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Telephone | 757-404-0296
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Fax |
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Provider Business Mailing Address
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Address Line | 300 32ND ST STE 420
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-2968
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Country | US
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Telephone | 757-404-0073
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JULIE REKANT
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Credential |
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Telephone | 757-404-0073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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