Southeastern Virginia Areawide Model Program

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

1060267354 Issued in VA

Legal business name

SOUTHEASTERN VIRGINIA AREAWIDE MODEL PROGRAM

Practice address

6350 Center Dr
Suite101
Norfolk, VA 23502-4107

Phone

(757) 461-9481

Fax

(757) 461-1068

NPI assigned

Jun 10, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. John N Skirven

Title

Ceo

Phone

(757) 222-4510

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Senior Services of Southeastern Virginia Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402358400000",
    "number": "1013320712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6350 CENTER DR",
            "address_2": "SUITE101",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235024107",
            "telephone_number": "757-461-9481",
            "fax_number": "757-461-1068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6350 CENTER DR",
            "address_2": "SUITE101",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235024107",
            "telephone_number": "757-461-9481",
            "fax_number": "757-461-1068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN VIRGINIA AREAWIDE MODEL PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-10",
        "last_updated": "2014-06-10",
        "status": "A",
        "authorized_official_last_name": "SKIRVEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "757-222-4510",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "VA",
            "license": "1060267354",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0160267354",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0161745051",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Senior Services of Southeastern Virginia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Cadorette Sotosky, DNP, CRNA
• Soulful & Tidy LLC
• Jerry Sourbeer Jr., DNP, CRNA
• Southeast Anesthesiology Consultants of Virginia, PLLC
• Southeast Pain & Spine Care Specialists, LLC
• Southern Bells Home Health Care LLC
• Southern Home Care Services, Inc.
• Southern Surgical Associates, PLLC T/a Norfolk Surgical Group
• Lynne Southern, CRNA
• Southerncare , Inc.

• Exclusive Provider Organization in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Exclusive Provider Organization in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.