Tidewater Surgical

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

TIDEWATER SURGICAL

Practice address

1732 S Park CT
Chesapeake, VA 23320-8934

Phone

(757) 995-5695

NPI assigned

Mar 31, 2020

Last updated

Jul 1, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Thomas Kirk

Title

Chief Executive Officer

Phone

(832) 804-8703

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1585612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625097600000",
    "number": "1821626235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1732 S PARK CT",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233208934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1732 S PARK CT",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233208934",
            "telephone_number": "757-995-5695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER SURGICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-31",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A",
        "authorized_official_last_name": "KIRK",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "832-804-8703"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tidewater Medical Clinic PC
• Tidewater Medical Supply, Inc
• Tidewater Physical Therapy, Inc.
• Tidewater Physical Therapy, LLC (Pivot Physical Therapy of Virginia)
• Tidewater Physical Therapy, LLC
• Tidewater Surgical Specialists, PLLC
• Tidewater Therapy for Children, PC
• Tidewater Therapy for Children, PC
• Tidewater Therapy for Children, PC
• Tidewater Therapy for Children, PC

• Specialist in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• Specialist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 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.