Western Tidewater Free Clinic INC
General Practice in Suffolk, VA. Organization (NPI-2).
NPI number1295219210
StatusActive
Last updated in NPPESSep 17, 2018
Details
- NPI
- 1295219210
- Entity type
- Organization (NPI-2)
- Legal business name
- Western Tidewater Free Clinic INC
- Organization subpart
- No
- Enumeration date
- Sep 17, 2018
- Last updated
- Sep 17, 2018
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208D00000X | General Practice | – | – | Yes |
Practice location
2019 Meade PkwySuffolk, VA 23434-4259
Phone 757-923-1060 · Fax 757-923-1068
Mailing address
2019 Meade PkwySuffolk, VA 23434-4259
Phone 757-923-1060 · Fax 757-923-1068
Authorized official
Chester Marvin Hart
Executive Director
7579231060
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