MEDICARE: OCEANA URGENT CARE AND FAMILY PRACTICE

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1477549558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEANA URGENT CARE AND FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	1232 PERIMETER PKWY
Second Line	:	SUITE 101
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-5689
Country	:	US
Telephone Number	:	757-425-8590
Fax Number	:	757-422-5107

Provider Business Practice Location Address
First Line	:	1232 PERIMETER PKWY
Second Line	:	SUITE 101
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-5689
Country	:	US
Telephone Number	:	757-425-8590
Fax Number	:	757-422-5107

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. LOU CARETTA
Credential	:
Telephone Number	:	757-622-8358

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	04/01/2008

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