Basic Information
| Provider Information | |||||||||
| NPI: | 1104835248 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EVMS HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 936 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235010936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574516266 | ||||||||
| FaxNumber: | 7574516251 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 COLLEY AVE | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235071627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574516266 | ||||||||
| FaxNumber: | 7574516251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 09/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | LIND | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXEC. OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7574467363 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | 1003887118 | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 49D0723270 | VA | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.