EMERGENCY PHYSICIAN OF TIDEWATER (NPI# 1851488167) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851488167 |
| Entity Type | Organization |
| Organization Name | EMERGENCY PHYSICIAN OF TIDEWATER |
| Practice Address |
4092 Foxwood Dr Suite 101 Virginia Beach VA 23462-5225 |
| Mailing Address |
309 Downing Dr Chesapeake VA 23322-8703 |
| Practice Telephone | 7574674200 |
| Practice Fax Number | 7574674173 |
| Mailing Telephone | 7574108879 |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. AKSEL KEKLIK (PHYSICIAN ASSISTANT) |
| Authorized Official Telephone | 7574108879 |
| Authorized Official Credential | PA-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282N00000X | General Acute Care Hospital | 0110001528 | VA | Hospitals |
| Street Address |
4092 FOXWOOD DR SUITE 101 |
| City | VIRGINIA BEACH |
| State | VA |
| Zip Code | 23462-5225 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700884343 | Joseph Scott Welch | Emergency Medicine | 4092 Foxwood Dr, Ste 101, Virginia Beach, VA 23462-5225 | 2005-07-08 |
| 1548735392 | Heather A Lustig | Physician Assistant | 4092 Foxwood Dr, Virginia Beach, VA 23462-5225 | 2018-10-09 |
| 1679066070 | Kendell Nicole Cobb | Physician Assistant | 4092 Foxwood Dr, Virginia Beach, VA 23462-5225 | 2018-06-11 |
| 1972002806 | Destiny Woods Houchin | Emergency Medicine | 4092 Foxwood Dr, Virginia Beach, VA 23462 | 2018-02-06 |
| 1417306317 | Kathryn Sidrow | Physician Assistant | 4092 Foxwood Dr, Suite 101, Virginia Beach, VA 23462-5225 | 2016-06-10 |
| 1295184737 | Liana Michelle Johnson | Physician Assistant | 4092 Foxwood Dr, Virginia Beach, VA 23462-5225 | 2016-06-06 |
| 1770937104 | Jacob Lunsford | Physician Assistant | 4092 Foxwood Dr, Suite 101, Virginia Beach, VA 23462-5225 | 2016-04-22 |
| 1962800649 | Stacey Alena Moody | Physician Assistant | 4092 Foxwood Dr, Suite 101, Virginia Beach, VA 23462-5225 | 2014-12-12 |
| 1114332020 | Victoria M Evelyn | Physician Assistant | 4092 Foxwood Dr, Virginia Beach, VA 23462-5225 | 2014-06-30 |
| 1568890473 | James L Thompson | Physician Assistant | 4092 Foxwood Dr, Ste 101, Virginia Beach, VA 23462-5225 | 2013-10-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912534082 | Cheyenne James | Counselor | 297 Independence Blvd., Virginia Beach, VA 23462 | 2020-03-26 |
| 1245871011 | Marathon Transportation Services LLC | Non-emergency Medical Transport (VAN) | 4505 Main Street, Apt 259, Virginia Beach, VA 23462 | 2019-10-03 |
| 1003475153 | Keyuri S Shah | Physical Therapist | 5701 Cleveland St, Ste 600, Virginia Beach, VA 23462 | 2019-06-12 |
| 1629561329 | Mary Katherine Pratt | Physician Assistant | 828 Healthy Way Ste 350, Virginia Beach, VA 23462 | 2018-06-07 |
| 1801387808 | Matrixx Healthcare LLC | Respite Care | 405 S Parliament Dr Ste 106, Virginia Beach, VA 23462 | 2018-05-24 |
| 1518471671 | Newtown Chiropractic Center Pllc | Clinic/Center | 5777 Princess Ann Road, Virginia Beach, VA 23462 | 2017-11-28 |
| 1528587995 | Gary Lee Alexander II | Counselor | 870 N Newtown Road, Virginia Beach, VA 23462 | 2017-09-16 |
| 1801328810 | Servitium Med Va, LLC | Durable Medical Equipment & Medical Supplies | 4445 Corporation Lane Suite 291, Virginia Beach, VA 23462 | 2017-03-29 |
| 1215476171 | Johnnie Walter Cox IIi | Emergency Medical Technician, Basic | 5163 Cleveland Street, Virginia Beach, VA 23462 | 2017-02-13 |
| 1225570179 | Holly Balsamo | Occupational Therapy Assistant | 5345 Marian Lane, Virginia Beach, VA 23462 | 2016-11-09 |
| Find all providers in zip 23462 | ||||
| Taxonomy Code | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003265075 | Chesapeake Hospital Authority | General Acute Care Hospital | 229 Clearfield Ave, Virginia Beach, VA 23462-1815 | 2016-06-09 |
| 1316343478 | Riverside Hospital, Inc | General Acute Care Hospital | 1200 First Colonial Rd, Suite 204a, Virginia Beach, VA 23454-2207 | 2014-11-17 |
| 1629038336 | Sentara Hospitals | General Acute Care Hospital | 1060 First Colonial Rd, Virginia Beach, VA 23454-3002 | 2006-03-25 |
| 1528028396 | Sentara Princess Anne Hospital | General Acute Care Hospital | 2025 Glenn Mitchell Dr, Virginia Beach, VA 23456-0178 | 2006-03-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538669445 | Virginia Hospital Center Arlington Health System | General Acute Care Hospital | 8100 Boone Blvd Ste 140, Vienna, VA 22182-2665 | 2018-02-16 |
| 1871020651 | Virginia Internal Medicine Specialists LLC | General Acute Care Hospital | 44790 Maynard Sq Ste 320, Ashburn, VA 20147-6514 | 2017-05-11 |
| 1730615816 | Sentara Healthcare | General Acute Care Hospital | 100 Ireland St, Hampton, VA 23663-2150 | 2017-05-10 |
| 1528592573 | New York Presbyterian Hospital-weill Cornell | General Acute Care Hospital | 9644 Sutton Green Ct, Vienna, VA 22181-6105 | 2017-04-17 |
| 1386181733 | Lyle Purnell | General Acute Care Hospital | 100 Emancipation Dr Bldg 146, Hampton, VA 23667-0001 | 2017-01-24 |
| 1700233855 | Debra Hafer | General Acute Care Hospital | 33290 Chincoteague Rd, Wallops Island, VA 23337-2204 | 2016-05-18 |
| 1093161374 | Mawussi Komi | General Acute Care Hospital | 6271 Drew Dr, Va Beach, VA 23464 | 2016-05-05 |
| 1700248796 | Hq Surgical | General Acute Care Hospital | 905 Hathaway Ct, Chesapeake, VA 23322-7622 | 2016-03-28 |
| 1710355649 | Johnston Memorial Hospital, Inc | General Acute Care Hospital | 3175 Linden Dr Ste 3-5, Bristol, VA 24202-5849 | 2015-09-09 |
| 1184092298 | Anita Sites | General Acute Care Hospital | Uva Transplant Center 1300 Jefferson Park Ave Fl 4, Charlottesville, VA 22908-3363 | 2015-09-04 |
| Find all providers with the same taxonomy | ||||
| City | VIRGINIA BEACH |
| Zip Code | 23462 |
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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.