Tidewater Radiation Services, LLC

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

License

2013-00861 Issued in NC

Legal business name

TIDEWATER RADIATION SERVICES, LLC

Practice address

1144 N Road St
Elizabeth City, NC 27909-3473

Phone

(252) 384-4122

Fax

(252) 384-4220

NPI assigned

Mar 9, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Janete M Mills, M.D.NPI 1639130602

Title

Owner

Phone

(252) 384-4122

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Janete M Mills, MD

  • Radiation Oncology Physician
  • Elizabeth City, VA
  • NPI 1639130602

  NC

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1425859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425859200000",
    "number": "1801289392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31476",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232941476",
            "telephone_number": "804-266-8717",
            "fax_number": "804-266-5677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1144 N ROAD ST",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279093473",
            "telephone_number": "252-384-4122",
            "fax_number": "252-384-4220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER RADIATION SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-09",
        "last_updated": "2015-03-09",
        "status": "A",
        "authorized_official_last_name": "MILLS",
        "authorized_official_first_name": "JANETE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-384-4122",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": "NC",
            "license": "2013-00861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Radiation Oncology Physician in Elizabeth City, NC
• Providers in Elizabeth City, NC by specialty
• Radiation Oncology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.