Tidewater Foot Center LLC

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

License

0103301081 Issued in VA

Legal business name

TIDEWATER FOOT CENTER LLC

Practice address

126 Monarch Dr
Newport News, VA 23602-6884

Phone

(757) 597-1520

Fax

(757) 597-7099

NPI assigned

Jul 29, 2013

Organization subpart

No

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

Authorized official

Name

Steven Thou Prak, D.P.MNPI 1033435219

Title

Sole Owner

Phone

(757) 597-7699

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 2

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

• Steven T Prak, DPM

  • Podiatrist
  • Newport News, VA
  • NPI 1033435219
  Medicare reassignment NPD Authorized official
• John E Brady, MD

  • Family Medicine Physician
  • Newport News, VA
  • NPI 1639118383
  NPD (past)

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

{
    "created_epoch": "1375056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386547200000",
    "number": "1891137048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11747 JEFFERSON AVE STE 2A",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236064402",
            "telephone_number": "757-597-7699",
            "fax_number": "757-597-7099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 MONARCH DR",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236026884",
            "telephone_number": "757-597-1520",
            "fax_number": "757-597-7099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER FOOT CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-29",
        "last_updated": "2013-12-09",
        "status": "A",
        "authorized_official_last_name": "PRAK",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "THOU",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "757-597-7699",
        "authorized_official_credential": "D.P.M"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "VA",
            "license": "0103301081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Tidewater Institute of NLP
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• Tidewater Physical Therapy, LLC
• Tidewater Physical Therapy, LLC

• Foot Surgery Podiatrist in Newport News, VA
• Providers in Newport News, VA by specialty
• Foot Surgery Podiatrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2013; 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.