MEDICARE: US NAVY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	146D00000X	Personal Emergency Response Attendant

General Provider Information

NPI Number	:	1003021502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	US NAVY

Provider Business Mailing Address
First Line	:	5972 BEECHWALK DRIVE
Second Line	:
City	:	VIRGINIA
State	:	VA
Zip	:	23464
Country	:	US
Telephone Number	:	850-774-5768
Fax Number	:

Provider Business Practice Location Address
First Line	:	5972 BEECHWALK DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4917
Country	:	US
Telephone Number	:	850-774-5768
Fax Number	:

Authorized Official
Title or Position	:	INDEPENDENT DUTY CORPSMAN
Name	:	MR. ANGELO LUIS SANCHEZ JR.
Credential	:	IDC
Telephone Number	:	757-462-3178

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	08/22/2020

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Directions to “US NAVY ” Practice Location

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