NPIMap

Organization Active NPI

Tricare Medical Clinic Suffolk

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Chesapeake, VA
National Provider Identifier
1821501719
Registry record updated Nov 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X
Legal business name
TRICARE MEDICAL CLINIC SUFFOLK
Practice address
1317 Ballahack Rd
Chesapeake, VA 23322-2499
Phone
(703) 681-9522
NPI assigned
Nov 14, 2017
Organization subpart
Yes
Parent organization
NAVAL MEDICAL CENTER PORTSMOUTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 14, 2017

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

Authorized official

Name
William M Condon
Title
Bumed Ubo
Phone
(240) 401-3643

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Military/U.S. Coast Guard Outpatient Clinic/Center 261QM1100X Primary

Addresses

Primary practice location

1317 Ballahack Rd
Chesapeake, VA 23322-2499

Mailing address

620 John Paul Jones Cir
Portsmouth, VA 23708-2111

National Provider Directory

National Provider Directory
Tax ID family
Sentara Obici Surgery Ctr - Navy Resource Sharing21 organizations share this tax ID, including this one
Part of
Sentara Obici Surgery Ctr - Navy Resource Sharing

Other organizations with this tax ID 20

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

View all 20

Locations

1317 Ballahack Rd
Chesapeake, VA 23322
Phone (757) 953-6248

NPI Registry JSON

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

{
    "created_epoch": "1510617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510617600000",
    "number": "1821501719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 JOHN PAUL JONES CIR",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237082111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 BALLAHACK RD",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233222499",
            "telephone_number": "703-681-9522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRICARE MEDICAL CLINIC SUFFOLK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NAVAL MEDICAL CENTER PORTSMOUTH",
        "enumeration_date": "2017-11-14",
        "last_updated": "2017-11-14",
        "status": "A",
        "authorized_official_last_name": "CONDON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BUMED UBO",
        "authorized_official_telephone_number": "240-401-3643"
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesapeake, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2017; 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.