TIDEWATER PROSTHETIC CENTER (NPI# 1578592408) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1578592408 |
Entity Type | Organization |
Organization Name | TIDEWATER PROSTHETIC CENTER |
Practice Address |
150 Burnetts Way Ste 300 Suffolk VA 23434-8177 |
Mailing Address |
4155 E La Palma Ave Ste B400 Anaheim CA 92807-1857 |
Practice Telephone | 7579254844 |
Practice Fax Number | 7579254973 |
Enumeration Date | 2006-07-02 |
Last Update Date | 2019-07-11 |
Authorized Official Name | GRACE ANGELINE (REG COMPLIANCE SPECIALIST III) |
Authorized Official Telephone | 7149612102 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 335E00000X | Prosthetic/Orthotic Supplier | CPO2647 | Suppliers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
VA | 9113568 | 05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1538340476 | Tidewater Prosthetic Center | Durable Medical Equipment & Medical Supplies | 5809 W Norfolk Rd, Portsmouth, VA 23703-3324 | 2007-11-20 |
1356522296 | Tidewater Prosthetic Center | Durable Medical Equipment & Medical Supplies | 6363 Center Dr Ste 100, Bldg 6, Norfolk, VA 23502-4103 | 2007-11-20 |
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 |
150 BURNETTS WAY STE 300 |
City | SUFFOLK |
State | VA |
Zip Code | 23434-8177 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1235780255 | Chiquita Savage | Home Health | You 1st Healthcare, 112 West Washington Street Suite 502, Suffolk, VA 23434 | 2019-09-20 |
1912561713 | Revivication Counseling Services | Counselor | 814 Cripple Creek Lane, Suffolk, VA 23434 | 2019-04-26 |
1558826958 | Nita Jenkins | Non-emergency Medical Transport (VAN) | 707 Gittings St. Suite 105, Suffolk, VA 23434 | 2019-02-10 |
1730660952 | Latrese L Riddick | Driver | 418 Jackson St, Suffolk, VA 23434 | 2018-08-25 |
1114411279 | Percilla D Zeno | Community Health Worker | 102 Niblick Cir, Suffolk, VA 23434 | 2018-06-21 |
1437652765 | Aprele Gaddie | Health Educator | 2769 Godwin Boulevard, Suffolk, VA 23434 | 2018-03-13 |
1598284283 | Domonic Teheran Scott | Driver | 102 Brewer Ave, Suffolk, VA 23434 | 2017-09-13 |
1578089397 | Nakia Shantel Francis | Nurse Practitioner | 2970 Godwin Blvd, Suite 320, Suffolk, VA 23434 | 2017-08-15 |
1679093009 | Daisy Mae Aba, LLC | Behavioral Analyst | 3212 Clearcreek Rd., Suffolk, VA 23434 | 2017-06-27 |
1114457736 | Better Care Family Homes | Day Training, Developmentally Disabled Services | 813 West Washington Street, Suffolk, VA 23434 | 2017-06-15 |
Find all providers in zip 23434 |
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 |
---|---|---|---|---|
1760583033 | Coastal Carolina Prosthetics & Orthotics, Inc. | Prosthetic/Orthotic Supplier | 148 Burnetts Way Ste 104, Suffolk, VA 23434-6149 | 2006-09-26 |
1164400552 | Progressive Prosthetic & Orthopedic Services, Inc. | Prosthetic/Orthotic Supplier | 1577 Wilroy Rd, Ste 300, Suffolk, VA 23434-2435 | 2006-01-05 |
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 |
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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.