IPS OF TIDEWATER, LLC (NPI# 1336400407) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336400407 |
| Entity Type | Organization |
| Organization Name | IPS OF TIDEWATER, LLC |
| Practice Address |
112 Gainsborough Sq Suite 200 Chesapeake VA 23320-1706 |
| Mailing Address |
Po Box 864820 Orlando FL 32886-0001 |
| Practice Telephone | 7575470798 |
| Practice Fax Number | 7575470145 |
| Mailing Telephone | 8883373509 |
| Mailing Fax Number | 9413283997 |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2012-06-05 |
| Authorized Official Name | DR. CARL R NOBACK (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 8883373509 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207L00000X | Anesthesiology | Allopathic & Osteopathic Physicians | ||
| Y | 367500000X | Nurse Anesthetist, Certified Registered | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
112 GAINSBOROUGH SQ SUITE 200 |
| City | CHESAPEAKE |
| State | VA |
| Zip Code | 23320-1706 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518941137 | Walid F Makdisi | Internal Medicine | 112 Gainsborough Sq, Suite 200, Chesapeake, VA 23320-1706 | 2005-12-06 |
| 1730529892 | Chantel Derise Dixon | Nurse Practitioner | 112 Gainsborough Sq, Suite 200, Chesapeake, VA 23320-1706 | 2013-07-03 |
| 1770757510 | Anthony Viol | Plastic Surgery | 112 Gainsborough Sq, Suite 100, Chesapeake, VA 23320-1706 | 2008-04-14 |
| 1356537054 | Rene Rivera | Internal Medicine | 112 Gainsborough Sq, Ste 200, Chesapeake, VA 23320-1706 | 2007-09-18 |
| 1952522161 | Shoba P Mendu | Internal Medicine | 112 Gainsborough Sq, Suite 200, Chesapeake, VA 23320-1706 | 2007-05-02 |
| 1356422927 | Diana B Tollaksen | Physician Assistant | 112 Gainsborough Sq, Suite 100, Chesapeake, VA 23320-1706 | 2006-10-18 |
| 1942300298 | Tidewater Gastroenterology,pllc | Internal Medicine | 112 Gainsborough Sq, Suite 200, Chesapeake, VA 23320-1706 | 2006-09-25 |
| 1891767547 | Brian Sullivan | Internal Medicine | 112 Gainsborough Sq, Suite 200, Chesapeake, VA 23320-1706 | 2006-02-06 |
| 1083691356 | Jeremy Peter Domanski | Internal Medicine | 112 Gainsborough Sq, Ste 200, Chesapeake, VA 23320-1706 | 2005-12-28 |
| 1124005830 | Felix P Tiongco | Internal Medicine | 112 Gainsborough Sq, Suite 200, Chesapeake, VA 23320-1706 | 2005-12-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386263499 | Trinity Hospice 1, LLC | Hospice Care, Community Based | 1401 Kempsville Road, Suite A, Unit 1, Chesapeake, VA 23320 | 2020-04-09 |
| 1538624804 | Shaniqah Mcleod | Home Health | 217 Centerville Turnpike N, Chesapeake, VA 23320 | 2019-01-31 |
| 1942764113 | Harris Teeter LLC | Durable Medical Equipment & Medical Supplies | 1400 Kempsville Rd, Virginia Beach, VA 23320 | 2019-01-22 |
| 1639647993 | Madison Vansavage Maben | Orthotist | 433 Network Sta, Chesapeake, VA 23320 | 2018-11-05 |
| 1568947356 | Kelly M Muchetti | Massage Therapist | 1421 C. Kempsville Rd., Chesapeake, VA 23320 | 2018-09-27 |
| 1235612912 | L&s Home Health Care, LLC. | Home Health | 1545 Cossways Blv, Chesepeake, VA 23320 | 2018-09-10 |
| 1154803500 | Latricia A Patterson | Home Health | 813-a Professional Pl Ste 107, Chesapeake, VA 23320 | 2018-09-02 |
| 1164909586 | 4k Tresses | Durable Medical Equipment & Medical Supplies | 1220 Executive Blvd Ste 101, Chesapeake, VA 23320 | 2018-07-27 |
| 1831676105 | Lance Taylor | Technician | 1645 Crossways Blvd Ste 250, Chesapeake, VA 23320 | 2018-07-19 |
| 1023507688 | Sentoria Howell Harold | Social Worker | 920 Ventures Way Ste 4, Chesapeake, VA 23320 | 2018-05-08 |
| Find all providers in zip 23320 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841680006 | Laura Edwards-stavrides | Nurse Anesthetist, Certified Registered | 736 North Battlefield Boulevard, Chesapeake, VA 23320 | 2015-01-27 |
| 1326055716 | Richard Wayne Cadorette | Nurse Anesthetist, Certified Registered | 917 Forest Lakes Cir, Chesapeake, VA 23322-7576 | 2006-08-01 |
| 1508836255 | Steven Edward Dichiara | Nurse Anesthetist, Certified Registered | 4419 Liam Close, Chesapeake, VA 23321-4259 | 2006-01-25 |
| 1841293362 | Susan Ann Maclary | Nurse Anesthetist, Certified Registered | 736 Battlefield Blvd N, Chesapeake, VA 23320-4941 | 2005-05-30 |
| 1588287585 | Kyle Timothy Shipe | Nurse Anesthetist, Certified Registered | 736 Battlefield Blvd N, Chesapeake, VA 23320-4941 | 2020-05-26 |
| 1609407683 | Anna Rose Lenczyk | Nurse Anesthetist, Certified Registered | 736 Battlefield Blvd N, Chesapeake, VA 23320-4941 | 2020-01-29 |
| 1679117048 | Eastern Virginia Anesthesia | Nurse Anesthetist, Certified Registered | 208 Carmichael Way, Chesapeake, VA 23322-2183 | 2019-10-29 |
| 1679044796 | Alison Sevier | Nurse Anesthetist, Certified Registered | 736 Battlefield Blvd N, Chesapeake, VA 23320-4941 | 2018-12-16 |
| 1376014498 | Danielle Gemender | Nurse Anesthetist, Certified Registered | 736 Battlefield Blvd N, Chesapeake, VA 23320-4941 | 2018-12-16 |
| 1093213340 | Mary Elizabeth Mann | Nurse Anesthetist, Certified Registered | 736 Battlefield Blvd N, Chesapeake, VA 23320-4941 | 2018-01-31 |
| Find all providers in CHESAPEAKE | ||||
| City | CHESAPEAKE |
| Zip Code | 23320 |
Please comment or provide details below to improve the information on IPS OF TIDEWATER, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.