NPIMap

Organization Active NPI

Tidewater Physicians Multispecialty Group PC

  • Professional Counselor
  • Newport News, VA
National Provider Identifier
1326428129
Registry record updated Nov 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
0701001988 Issued in VA
Legal business name
TIDEWATER PHYSICIANS MULTISPECIALTY GROUP PC
Practice address
860 Omni Blvd Ste 401
Newport News, VA 23606-4430
Phone
(757) 232-8764
NPI assigned
Jun 5, 2015
Last updated
Nov 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2021

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

Authorized official

Name
Angela Walker
Title
Credentialing Manager
Phone
(757) 232-8769

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 0701001988 VA Primary

Addresses

Primary practice location

860 Omni Blvd Ste 401
Newport News, VA 23606-4430

Mailing address

11761 Rock Landing Dr Ste 8
Newport News, VA 23606-4235
Phone (757) 232-8769

National Provider Directory

National Provider Directory
Tax ID family
Tidewater Physicians Multi3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

860 Omni Blvd
Ste 101
Newport News, VA 23606
Phone (757) 223-9794

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1433462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636416000000",
    "number": "1326428129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11761 ROCK LANDING DR STE 8",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236064235",
            "telephone_number": "757-232-8769",
            "fax_number": "757-232-8875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 OMNI BLVD STE 401",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236064430",
            "telephone_number": "757-232-8764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER PHYSICIANS MULTISPECIALTY GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-05",
        "last_updated": "2021-11-09",
        "certification_date": "2021-11-09",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "CREDENTIALING  MANAGER",
        "authorized_official_telephone_number": "757-232-8769"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701001988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport News, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 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.