TIDEWATER FOOT CENTER LLC (NPI# 1891137048) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891137048 |
| Entity Type | Organization |
| Organization Name | TIDEWATER FOOT CENTER LLC |
| Practice Address |
126 Monarch Dr Newport News VA 23602-6884 |
| Mailing Address |
11747 Jefferson Ave Ste 2a Newport News VA 23606-4402 |
| Practice Telephone | 7575971520 |
| Practice Fax Number | 7575977099 |
| Mailing Telephone | 7575977699 |
| Mailing Fax Number | 7575977099 |
| Enumeration Date | 2013-07-29 |
| Last Update Date | 2013-12-09 |
| Authorized Official Name | STEVEN THOU PRAK (SOLE OWNER) |
| Authorized Official Telephone | 7575977699 |
| Authorized Official Credential | D.P.M |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0131X |
Podiatrist Specialization: Foot Surgery |
0103301081 | VA | Podiatric Medicine & Surgery Service Providers |
| Street Address |
126 MONARCH DR |
| City | NEWPORT NEWS |
| State | VA |
| Zip Code | 23602-6884 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538789425 | Aishah Naomi Khursheed | Counselor | 727 J Clyde Blvd, Ste A, Newport News, VA 23602 | 2020-04-21 |
| 1962069526 | Boss Inner Child Counseling, LLC | Clinic/Center | 14203 Old Courthouse Way, Suite B, Newport News, VA 23602 | 2019-05-20 |
| 1922598572 | Manoj Chawla | Internal Medicine | 1000 Old Denbigh Blvd # 1020a, Newport News, VA 23602 | 2018-05-18 |
| 1750896999 | Alexandra Paige Jones | Behavioral Analyst | 12727 Mcmanus Blvd., Newport News, VA 23602 | 2017-12-11 |
| 1457712556 | Mary Ellen Lynch | Registered Nurse | American Addiction Treatment Center, 12695 Mcmanus Blvd, Bdg 2, Newport News, VA 23602 | 2016-03-16 |
| 1790159481 | Megan Ashley Burkart Schmidt | Registered Nurse | 903 Kinsale Cres, Newport News, VA 23602 | 2015-11-18 |
| 1962870733 | Natalie Marie Bradshaw-smith | Nurse Practitioner | 401 Oyster Point Rd Ste A, Newport News, VA 23602 | 2015-09-09 |
| 1477953578 | Jonathan Edwards | Pathology | Bon Secours Mary Immaculate Hospital, Pathology Dept, 2 Bernardine Dr, Newport News, VA 23602 | 2014-08-26 |
| 1588063663 | Cathy G Cooke | Psychologist | 12695 Mcmanus Blvd. Bldg #8, Newport News, VA 23602 | 2014-08-14 |
| 1538576764 | John Michael Sullivan | Psychologist | One Old Oyster Point Road, Newport News, VA 23602 | 2014-07-21 |
| Find all providers in zip 23602 | ||||
| Taxonomy Code | 213ES0131X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790721223 | Howard Michael Roesen | Podiatrist | 754 Mcguire Pl, Newport News, VA 23601-1630 | 2006-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528666971 | Virtual Foot and Ankle Care, LLC | Podiatrist | 5970 Derwent Rd, Powhatan, VA 23139-4620 | 2020-10-16 |
| 1346540515 | All American Podiatry and Wound Care, P.C. | Podiatrist | 4620 Bunker Hill Ln, Virginia Beach, VA 23462-2245 | 2010-10-22 |
| 1740411925 | Srikanth Mahavadi | Podiatrist | 9050 Pocahontas Trail, Suite F, Providence Forge, VA 23140 | 2009-08-05 |
| 1942326137 | Rosemary Cecile O'grady | Podiatrist | 1942 William St, Fredericksburg, VA 22401-5128 | 2007-03-21 |
| 1144360058 | Podiatric Care of Northern Virginia, PC | Podiatrist | 821 S King St Ste I, Leesburg, VA 20175-3922 | 2007-02-08 |
| 1477638526 | Jerald A. Kriger | Podiatrist | 8605 Sudley Rd, Manassas, VA 20110-4583 | 2006-10-26 |
| 1275623043 | Virginia Footcare Center, LLC | Podiatrist | 2848 Jefferson Davis Hwy, Suite 114, Stafford, VA 22554-1767 | 2006-10-13 |
| 1265538979 | Paul Thomas Spada | Podiatrist | 533 Rodney Ln, Virginia Beach, VA 23464-2227 | 2006-09-16 |
| 1538279260 | Hampton Roads Podiatry PC | Podiatrist | 5241 Princess Anne Road Suite 102, Va Beach, VA 23462 | 2006-08-30 |
| 1326152976 | Mukesh D. Bhakta | Podiatrist | 7430 Heritage Village Plz Unit 101, Gainesville, VA 20155-3089 | 2006-08-19 |
| Find all providers with the same taxonomy | ||||
| City | NEWPORT NEWS |
| Zip Code | 23602 |
Please comment or provide details below to improve the information on TIDEWATER FOOT CENTER LLC.
| 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.