Basic Information
| Provider Information | |||||||||
| NPI: | 1417602749 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHESAPEAKE HOSPITAL AUTHORITY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 667 KINGSBOROUGH SQ STE 101 | ||||||||
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| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233204999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573124481 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 PLANK BRIDGE ROAD | ||||||||
| Address2: | STE B | ||||||||
| City: | CAMDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523311829 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2022 | ||||||||
| LastUpdateDate: | 02/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | MCDONNELL | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | CRAIG | ||||||||
| AuthorizedOfficialTitleorPosition: | VP/CFO | ||||||||
| AuthorizedOfficialTelephone: | 7573123138 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CHESAPEAKE HOSPITAL AUTHORITY | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 02/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.