Tidewater Rehabilitation Medicine

LBN: Tidewater Rehabilitation Medicine
Tidewater Rehabilitation Medicine is an health care organization with primary practice located at 1120 First Colonial Rd Suite 206, Virginia Beach VA 23454-2418. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is the primary health care specialty. Tidewater Rehabilitation Medicine can be contacted via phone (757) 496-2325, or through Kayota, Stephen Walter via phone (757) 496-2325.

Contact Information

Primary practice address
1120 First Colonial Rd Suite 206 Virginia Beach VA 23454-2418
Phone: (757) 496-2325
Fax: (757) 496-1942
Website:
Map and Directions
Authorized official contact:
Name: Kayota, Stephen Walter Doctor of Medicine (MD)
Phone: (757) 496-2325

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 0101053621 Virginia
Allopathic & Osteopathic Physicians / Pain Medicine 2081P2900X 0101053621 Virginia

Profile Details

NPI number 1891113155
LBN Legal business name Tidewater Rehabilitation Medicine
DBA Doing business as
Authorized official Kayota, Stephen Walter Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Apr 3rd, 2014
Last updated Apr 25th, 2015 - about 10 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 1891113155 NPPES
Virginia Other 1891113155 AETNA
Virginia Other 1891113155 AETNA
Virginia MEDICAID 1891113155 AETNA
Virginia Other 1891113155 AETNA
Virginia Other 1891113155 AETNA
Virginia Other 1891113155 AETNA
Virginia Other 1891113155 AETNA
Virginia Other 1891113155 AETNA
Virginia Other 1891113155 AETNA
Virginia Other 618120600 AETNA
Virginia Other 1891113155 AETNA

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