TIDEWATER FOOT CENTER LLC NPI 1891137048

NPI Information

NPI: 1891137048
Provider Name: TIDEWATER FOOT CENTER LLC
Classification: Podiatrist - 213ES0131X
Entity Type: Organization

Specialization: Foot Surgery

Address:
126 MONARCH DR
NEWPORT NEWS, VA
ZIP 23602
Phone: (757) 597-1520
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TIDEWATER FOOT CENTER LLC is a foot surgery podiatrist in Newport News, VA. TIDEWATER FOOT CENTER LLC NPI is 1891137048. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

126 MONARCH DR
NEWPORT NEWS, VA
ZIP 23602-884
Phone: (757) 597-1520
Fax: (757) 597-7099

The provider's authorized official is Steven Thou Prak .
The authorized official title is Sole Owner and has the following contact phone number (757) 597-7699.

The enumeration date for this NPI number is 7/29/2013 and was last updated on 12/9/2013.

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
1	213ES0131X	Podiatrist	Foot Surgery	0103301081	VIRGINIA	Yes

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: 5/5/2024

NPI Synchronization or Removal

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