TIDEWATER RADIATION SERVICES LLC NPI 1801289392

NPI Information

  • NPI: 1801289392
  • Provider Name: TIDEWATER RADIATION SERVICES, LLC
  • Classification: Radiology - 2085R0001X
  • Specialization: Radiation Oncology
  • Entity Type: Organization
  • Address: 1144 N ROAD ST
    ELIZABETH CITY, NC
    ZIP 27909
  • Phone: (252) 384-4122

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NPI Details

TIDEWATER RADIATION SERVICES, LLC is a radiation oncology radiology in Elizabeth City, NC. The provider is a radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. TIDEWATER RADIATION SERVICES, LLC NPI is 1801289392. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1144 N ROAD ST
ELIZABETH CITY, NC
ZIP 27909-473
Phone: (252) 384-4122
Fax: (252) 384-4220

The provider's authorized official is Janete M Mills .
The authorized official title is Owner and has the following contact phone number (252) 384-4122.

The enumeration date for this NPI number is 3/9/2015 and was last updated on 3/9/2015.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12085R0001XRadiologyRadiation Oncology2013-00861NORTH CAROLINAYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1G33791MEDICARE UPIN

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: 11/21/2025

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