TIDEWATER PROSTHETIC CENTER (NPI# 1538340476) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538340476 |
| Entity Type | Organization |
| Organization Name | TIDEWATER PROSTHETIC CENTER |
| Practice Address |
5809 W Norfolk Rd Portsmouth VA 23703-3324 |
| Mailing Address |
4155 E La Palma Ave Ste B400 Anaheim CA 92807-1857 |
| Practice Telephone | 7579254844 |
| Practice Fax Number | 7576860900 |
| Mailing Telephone | 7149612102 |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2019-07-19 |
| Authorized Official Name | GRACE ANGELINE (REG COMPLIANCE SPECIALIST III) |
| Authorized Official Telephone | 7149612102 |
| Is Organization Subpart | Y |
| Parent Organization Name | TIDEWATER PROSTHETIC CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 335E00000X | Prosthetic/Orthotic Supplier | CPO2647 | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 1538340476 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356522296 | Tidewater Prosthetic Center | Durable Medical Equipment & Medical Supplies | 6363 Center Dr Ste 100, Bldg 6, Norfolk, VA 23502-4103 | 2007-11-20 |
| 1578592408 | Tidewater Prosthetic Center | Prosthetic/Orthotic Supplier | 150 Burnetts Way Ste 300, Suffolk, VA 23434-8177 | 2006-07-02 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | TIDEWATER PROSTHETIC CENTER INC. | 10910 Domain Drive Ste 300, Austin, Texas 78758 |
| System for Award Management (SAM) Entities | TIDEWATER PROSTHETIC CENTER, INC | 150 Burnetts Way Ste 300, Suffolk, VA 23434-8177 |
| Street Address |
5809 W NORFOLK RD |
| City | PORTSMOUTH |
| State | VA |
| Zip Code | 23703-3324 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174037444 | Kelly Foster | Massage Therapist | 3108 Tyre Neck Rd Ste D, Portsmouth, VA 23703 | 2017-11-25 |
| 1578072104 | Katherine Armstrong Wise | Behavior Technician | 3120 Verne Ave, Portsmouth, VA 23703 | 2017-09-27 |
| 1891223913 | Ashley Rebecca Anderson | Dentist | 5915 High Street W, Portsmouth, VA 23703 | 2017-06-02 |
| 1881126019 | Anas Elmahdi | Specialist | 5205 Sweetbriar C., 5205 Sweetbriar C., Portsmouth, VA 23703 | 2017-03-28 |
| 1578003554 | Elyse Buttery | Nurse Practitioner | Mast One 1040 University Blvd, Suite 200, Portsmouth, VA 23703 | 2017-02-24 |
| 1376948349 | Charles Douglas Knight | Military Health Care Provider | Uss Maryland Ssbn 738, Fpo, AA 23703 | 2014-11-03 |
| 1689929382 | Positive Connections, Inc | Community/Behavioral Health | 3823d Meherrin River Reach, Portsmouth, VA 23703 | 2012-07-18 |
| 1225319874 | Sanaz Namin | Pharmacist | 5601 High Street, Porstmouth, VA 23703 | 2011-09-08 |
| 1295029767 | Maggie Jackson | Dental Hygienist | 4000 Coast Guard Blvd., Portsmouth, VA 23703 | 2011-06-02 |
| 1679804892 | Amy Kathleenn Gaspar | Specialist/Technologist, Other | 4113 Pendleton Rd, Portsmouth, VA 23703 | 2010-01-28 |
| Find all providers in zip 23703 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730519893 | Beautiful Nation | Prosthetic/Orthotic Supplier | 3011 Victory Blvd, Portsmouth, VA 23702-1827 | 2013-11-26 |
| 1245572221 | New Hampshire Prosthetics LLC | Prosthetic/Orthotic Supplier | 30 International Dr Ste 201, Portsmouth, NH 03801-6812 | 2013-03-18 |
| 1073610721 | Comfort Zone Shoes and Footbeds LLC | Prosthetic/Orthotic Supplier | 880 E Main Rd, Portsmouth, RI 02871-2340 | 2006-09-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548869324 | Reach Orthotic & Prosthetic Service, Inc. | Prosthetic/Orthotic Supplier | 4057 Taylor Rd Ste P, Chesapeake, VA 23321-5527 | 2020-10-22 |
| 1982203709 | Reach Orthotic & Prosthetic Service, Inc. | Prosthetic/Orthotic Supplier | 211 Bulifants Blvd Ste B, Williamsburg, VA 23188-5741 | 2020-10-22 |
| 1225637028 | Reach Orthotic & Prosthetic Service, Inc. | Prosthetic/Orthotic Supplier | 6251 E Virginia Beach Blvd Ste 135, Norfolk, VA 23502-2824 | 2020-10-22 |
| 1326657818 | Hairsonality Rx | Prosthetic/Orthotic Supplier | 110 Coliseum Xing # 5126, Hampton, VA 23666-5971 | 2020-07-30 |
| 1699393850 | Bionic Innovations LLC | Prosthetic/Orthotic Supplier | 896 Haden Ln, Crozet, VA 22932-2833 | 2020-07-13 |
| 1821610361 | Takeria Lewis | Prosthetic/Orthotic Supplier | 300 Karl Linn Dr Apt 115, North Chesterfield, VA 23225-6979 | 2020-05-06 |
| 1033740139 | Hair Saviours | Prosthetic/Orthotic Supplier | 25 Cornerstone Dr, Stafford, VA 22554-6208 | 2020-01-28 |
| 1689212078 | Monica Evette Dickenson | Prosthetic/Orthotic Supplier | 2001 Southampton St, Woodbridge, VA 22191-2660 | 2019-12-16 |
| 1588202105 | Boston Brace International Inc. | Prosthetic/Orthotic Supplier | 7301 Forest Ave Ste 202, Richmond, VA 23226-3792 | 2019-12-13 |
| 1396388187 | Seven Degree North Hair | Prosthetic/Orthotic Supplier | 700 Lombardy Ave Apt 7402, Newport News, VA 23606-3367 | 2019-10-24 |
| Find all providers with the same taxonomy | ||||
| City | PORTSMOUTH |
| Zip Code | 23703 |
Please comment or provide details below to improve the information on TIDEWATER PROSTHETIC CENTER.
| 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.