NPIMap

Organization Active NPI

Tidewater Anesthesia Inc

  • Certified Registered Nurse Anesthetist
  • Virginia Beach, VA
National Provider Identifier
1063583722
Registry record updated May 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
TIDEWATER ANESTHESIA INC
Practice address
1200 First Colonial Rd
Virginia Beach, VA 23454-2207
Phone
(888) 209-0305
Fax
(952) 442-3620
NPI assigned
Nov 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2020

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

Authorized official

Name
Marsha Faison Edwards, CRNANPI 1902891005
Title
President
Phone
(757) 403-6728

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

1200 First Colonial Rd
Virginia Beach, VA 23454-2207

Mailing address

400 10TH St E
Waconia, MN 55387-4552
Phone (888) 209-0305

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050224000932 VA Part B Supplier - Clinic/Group Practice 2264485713 Receives reassigned benefits from 12 practitioners
Practice locations: Virginia Beach, VA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589932800000",
    "number": "1063583722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 10TH ST E",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553874552",
            "telephone_number": "888-209-0305",
            "fax_number": "952-442-3620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 FIRST COLONIAL RD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234542207",
            "telephone_number": "888-209-0305",
            "fax_number": "952-442-3620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER ANESTHESIA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2020-05-20",
        "certification_date": "2020-05-20",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "MARSHA",
        "authorized_official_middle_name": "FAISON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-403-6728",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.