WESTERN TIDEWATER FREE CLINIC INC NPI 1295219210

NPI Information

  • NPI: 1295219210
  • Provider Name: WESTERN TIDEWATER FREE CLINIC INC
  • Classification: General Practice - 208D00000X
  • Entity Type: Organization
  • CLIA Number: 49D1076912
  • Address: 2019 MEADE PKWY
    SUFFOLK, VA
    ZIP 23434
  • Phone: (757) 923-1060

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NPI Details

WESTERN TIDEWATER FREE CLINIC INC is a general practice in Suffolk, VA. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee WESTERN TIDEWATER FREE CLINIC INC NPI is 1295219210. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2019 MEADE PKWY
SUFFOLK, VA
ZIP 23434-259
Phone: (757) 923-1060
Fax: (757) 923-1068

The provider's authorized official is Chester Marvin Hart .
The authorized official title is Executive Director and has the following contact phone number (757) 923-1060.

The CLIA number assigned to this NPI record is 49D1076912 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/17/2018 and was last updated on 9/17/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208D00000XGeneral PracticeYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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