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TIDEWATER KIDNEY SPECIALISTS INC. NPI 1780624627


NPI Information

NPI: 1780624627
Provider Name: TIDEWATER KIDNEY SPECIALISTS, INC.
Classification: Internal Medicine - 207RN0300X
Entity Type: Organization

Specialization: Nephrology

Address:
4445 CORPORATION LN STE 100
VIRGINIA BEACH, VA
ZIP 23462
Phone: (757) 623-0005
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TIDEWATER KIDNEY SPECIALISTS, INC. is a nephrology internal medicine in Virginia Beach, VA. The provider is an internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. TIDEWATER KIDNEY SPECIALISTS, INC. NPI is 1780624627. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4445 CORPORATION LN STE 100
VIRGINIA BEACH, VA
ZIP 23462-666
Phone: (757) 623-0005
Fax: (757) 548-1129

The provider's authorized official is Elizabeth Skidmore .
The authorized official title is Administrator and has the following contact phone number (757) 623-0005.

The enumeration date for this NPI number is 6/8/2006 and was last updated on 1/20/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialistVIRGINIANo
2207RN0300XInternal MedicineNephrologyVIRGINIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1890129JMEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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