Basic Information
| Provider Information | |||||||||
| NPI: | 1497740708 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PATIENT CHOICE GHENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1232 PERIMETER PKWY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234545689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574258590 | ||||||||
| FaxNumber: | 7574225107 | ||||||||
| Practice Location | |||||||||
| Address1: | 957E WEST 21ST ST | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235171536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576228358 | ||||||||
| FaxNumber: | 7576229662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 03/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | CARETTA | ||||||||
| AuthorizedOfficialFirstName: | LOU | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7574258590 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.