Colon Rectal Surgery Of Tidewater, P.C.

LBN: Colon Rectal Surgery Of Tidewater, P.C.
Colon Rectal Surgery Of Tidewater, P.C. is an health care organization with primary practice located at 3235 Academy Ave Suite 100, Portsmouth VA 23703-3200. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Colon & Rectal Surgery, which is considered as the primary health care specialty. Colon Rectal Surgery Of Tidewater, P.C. can be contacted via phone (757) 484-9653, or through Wolf, Jeffrey Stephen via phone (757) 484-9653.

Contact Information

Primary practice address
3235 Academy Ave Suite 100 Portsmouth VA 23703-3200
Phone: (757) 484-9653
Fax: (757) 484-9662
Website:
Map and Directions
Authorized official contact:
Name: Wolf, Jeffrey Stephen Doctor of Medicine (MD)
Phone: (757) 484-9653

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Colon & Rectal Surgery 208C00000X 0101031444 Virginia

Profile Details

NPI number 1790794022
LBN Legal business name Colon Rectal Surgery Of Tidewater, P.C.
DBA Doing business as
Authorized official Wolf, Jeffrey Stephen Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Aug 5th, 2006
Last updated Sep 14th, 2011 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790794022 NPPES
Virginia MEDICAID 005841232
Virginia Other 072337
Virginia Other 200136
Virginia Other 292832
Virginia MEDICAID 890528E

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