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1942300298 NPI number — TIDEWATER GASTROENTEROLOGY,PLLC

NPI Number: 1942300298
Health Care Provider/Practitioner: TIDEWATER GASTROENTEROLOGY,PLLC

Information about “1942300298” NPI (TIDEWATER GASTROENTEROLOGY,PLLC) exists in 1942300298 in HTML format HTML  |  1942300298 in plain Text format TXT  |  1942300298 in PDF (Portable Document Format) PDF  |  1942300298 in an XML format XML  formats.

NPI Number : 1942300298 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1942300298",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "TIDEWATER GASTROENTEROLOGY,PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 381468",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GERMANTOWN",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "38183-1468",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "901-737-4665",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "661 INDEPENDENCE PKWY STE 120",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHESAPEAKE",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23320-5164",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "757-547-0798",
    "PracticeLocationAddressFaxNumber": "757-547-0145",
    "EnumerationDate": "09/25/2006",
    "LastUpdateDate": "01/14/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "JUDY",
    "AuthorizedOfficialFirstName": "AIMEE",
    "AuthorizedOfficialMiddleName": "CATHLEEN",
    "AuthorizedOfficialTitle": "DIRECTOR, CREDENTIALING",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "901-737-4665",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207RG0100X",
        "TaxonomyName": "Gastroenterology Physician",
        "LicenseNumber": "0101023966",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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