Tidewater Medical Supply, Inc

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

0206009115 Issued in VA

Legal business name

TIDEWATER MEDICAL SUPPLY, INC

Practice address

525 Byron St
Suite a
Chesapeake, VA 23320-7967

Phone

(757) 548-9999

Fax

(757) 549-7752

NPI assigned

Sep 17, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Keith Anthony Davies

Title

President

Phone

(757) 548-9999

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1158451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268265600000",
    "number": "1104923895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 BYRON ST",
            "address_2": "SUITE A",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233207967",
            "telephone_number": "757-548-9999",
            "fax_number": "757-549-7752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 BYRON ST",
            "address_2": "SUITE A",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233207967",
            "telephone_number": "757-548-9999",
            "fax_number": "757-549-7752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER MEDICAL SUPPLY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-17",
        "last_updated": "2010-03-11",
        "status": "A",
        "authorized_official_last_name": "DAVIES",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-548-9999",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "VA",
            "license": "0206009115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PARTICIPATING PROVIDER ID # 1258980001 STATE VA PTAN #",
            "identifier": "1258980001",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009117920",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tidewater Family Medical Care, PC
• Tidewater Healthcare Services, Inc
• Tidewater Home Modifiers LLC
• Tidewater Internal Medicine and Hypertension Center. PLC
• Tidewater Medical Clinic PC
• Tidewater Physical Therapy, Inc.
• Tidewater Physical Therapy, LLC
• Tidewater Physical Therapy, LLC
• Tidewater Surgical
• Tidewater Surgical Specialists, PLLC

• Oxygen Equipment & Supplies (DME) in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• Oxygen Equipment & Supplies (DME) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2010; 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.