MEDICARE: NMC PORTSMOUTH

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	332000000X	Military/U.S. Coast Guard Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2146174	OTHER		PK

General Provider Information

NPI Number	:	1396158168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NMC PORTSMOUTH

Provider Business Mailing Address
First Line	:	THIRD PARTY COLLECTIONS
Second Line	:	620 JOHN PAUL JONES CIR
City	:	PORTHSMOUTH
State	:	VA
Zip	:	23708-2111
Country	:	US
Telephone Number	:	757-953-9881
Fax Number	:	757-953-9908

Provider Business Practice Location Address
First Line	:	1885 TERRIER AVE STE 100
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23461-2205
Country	:	US
Telephone Number	:	757-953-9881
Fax Number	:	757-953-9908

Authorized Official
Title or Position	:	UBO MANAGER
Name	:	WILLIAM M CONDON
Credential	:
Telephone Number	:	240-401-3643

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	05/30/2025

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Directions to “NMC PORTSMOUTH ” Practice Location

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