Tsi Tidewater LLC

Primary specialty

Home Infusion Therapy PharmacyTaxonomy code 3336H0001X

Legal business name

TSI TIDEWATER LLC

Doing business as

Vital Care of Suffolk

Practice address

1520 Breezeport Way Ste 500
Suffolk, VA 23435-3757

Phone

(757) 861-0050

Fax

(757) 335-7354

NPI assigned

Jan 11, 2023

Last updated

May 12, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amanda McDonald, PHARMACISTSNPI 1316696016

Title

Managing Pharmacists

Phone

(757) 861-0050

Specialties & licenses 4

Addresses

Other names 1

• Vital Care of Suffolk Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Amanda McDonald, PHARMD

  • Pharmacist
  • Raleigh, NC
  • NPI 1316696016
  NPD Authorized official
• Nequa Powell

  • Pharmacist
  • Suffolk, VA
  • NPI 1336912260
  NPD

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

{
    "created_epoch": "1673395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683849600000",
    "number": "1114631447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 BREEZEPORT WAY STE 500",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234353757",
            "telephone_number": "757-861-0050",
            "fax_number": "757-335-7354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 BREEZEPORT WAY STE 500",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234353757",
            "telephone_number": "757-861-0050",
            "fax_number": "757-335-7354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TSI TIDEWATER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-11",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "MANAGING PHARMACISTS",
        "authorized_official_telephone_number": "757-861-0050",
        "authorized_official_credential": "PHARMACISTS"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vital Care of Suffolk",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vital Care of Suffolk",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Home Infusion Therapy Pharmacy in Suffolk, VA
• Providers in Suffolk, VA by specialty
• Home Infusion Therapy Pharmacy in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.