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TIDEWATER REHABILITATION MEDICINE NPI 1891113155


NPI Information

NPI: 1891113155
Provider Name: TIDEWATER REHABILITATION MEDICINE
Classification: Physical Medicine & Rehabilitation - 2081P2900X
Entity Type: Organization

Specialization: Pain Medicine

CLIA Number: 49D1010447

Address:
1120 FIRST COLONIAL RD
SUITE 206
VIRGINIA BEACH, VA
ZIP 23454
Phone: (757) 496-2325
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TIDEWATER REHABILITATION MEDICINE is a pain medicine physical medicine rehabilitation in Virginia Beach, VA. The provider is a physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. TIDEWATER REHABILITATION MEDICINE NPI is 1891113155. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

1120 FIRST COLONIAL RD
SUITE 206
VIRGINIA BEACH, VA
ZIP 23454-418
Phone: (757) 496-2325
Fax: (757) 496-1942

The provider's authorized official is Stephen Walter Kayota .
The authorized official title is Sole Owner/authorize Official and has the following contact phone number (757) 496-2325.

The CLIA number assigned to this NPI record is 49D1010447 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 4/3/2014 and was last updated on 4/25/2015.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208100000XPhysical Medicine & Rehabilitation0101053621VIRGINIANo
22081P2900XPhysical Medicine & RehabilitationPain Medicine0101053621VIRGINIAYes

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
11891113155OTHERVIRGINIAUNITED HEALTHCARE
21891113155OTHERVIRGINIAAETNA
31891113155OTHERVIRGINIAANTHEM BCBS VA
4618120600OTHERVIRGINIADEPARTMENT OF LABOR
51891113155OTHERVIRGINIACIGNA
61891113155OTHERVIRGINIAVIRGINIA HEALTH NETWORK
71891113155OTHERVIRGINIAHUMANA MEDICARE
81891113155OTHERVIRGINIACOVENTRY
9D620MEDICARE PINVIRGINIA
101891113155OTHERVIRGINIAOPTIMA
111891113155OTHERVIRGINIATRICARE
121891113155MEDICAIDVIRGINIA

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: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.