Intrepid of Tidewater, Inc.

Primary specialty

Hospice and Palliative Medicine (Family Medicine) PhysicianTaxonomy code 207QH0002X

Legal business name

INTREPID OF TIDEWATER, INC.

Doing business as

Intrepid Palliative & Supportive Care

Practice address

101 W Main St
Radford, VA 24141-1582

Phone

(540) 639-3280

NPI assigned

Aug 5, 2021

Organization subpart

No

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

Authorized official

Name

Robert Parker, CCO

Title

Chief Compliance Officer

Phone

(214) 445-3750

Specialties & licenses 1

Addresses

Other names 1

• Intrepid Palliative & Supportive Care Doing business as

Locations

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

{
    "created_epoch": "1628121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628121600000",
    "number": "1245904994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3220 KELLER SPRINGS RD STE 108",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750065911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W MAIN ST",
            "city": "RADFORD",
            "state": "VA",
            "postal_code": "241411582",
            "telephone_number": "540-639-3280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTREPID OF TIDEWATER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-05",
        "last_updated": "2021-08-05",
        "certification_date": "2021-08-05",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "214-445-3750",
        "authorized_official_credential": "CCO"
    },
    "taxonomies": [
        {
            "code": "207QH0002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Intrepid Palliative & Supportive Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hilary Riley Hozey, MD
• Christie Deneise Hurley, COTA/L, BA
• Rhoda Elena Hurst, PH. D, LCSW
• Vickie Rosalie Hylton, RD
• Intrepid of Piedmont Ridge, Inc.
• Scott Irwin, CRNA
• J.L. Felger, D.C. P.a.
• Daniel G Jaasma
• Bryce Jackson, ATC
• Shakia Jackson

• Hospice and Palliative Medicine (Family Medicine) Physician in Radford, VA
• Providers in Radford, VA by specialty
• Hospice and Palliative Medicine (Family Medicine) Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; 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.