Tidewater Homespec, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

2705096060 Issued in VA

Legal business name

TIDEWATER HOMESPEC, LLC

Practice address

1024 Patrick Henry Way
Virginia Beach, VA 23455-4826

Phone

(757) 409-1969

NPI assigned

Oct 13, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Clarence O Longmore III

Title

Managing Partner

Phone

(757) 409-1969

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1223856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223856000000",
    "number": "1790937589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1024 PATRICK HENRY WAY",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234554826",
            "telephone_number": "757-409-1969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1024 PATRICK HENRY WAY",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234554826",
            "telephone_number": "757-409-1969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER HOMESPEC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-13",
        "last_updated": "2008-10-13",
        "status": "A",
        "authorized_official_last_name": "LONGMORE",
        "authorized_official_first_name": "CLARENCE",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "MANAGING  PARTNER",
        "authorized_official_telephone_number": "757-409-1969",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "VA",
            "license": "2705096060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Tidewater Medical Care PC

• Durable Medical Equipment & Medical Supplies in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Durable Medical Equipment & Medical Supplies in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2008; 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.