Provider Demographics
NPI:1073524484
Name:COMPREHENSIVE MEDICAL CENTER I INC
Entity Type:Organization
Organization Name:COMPREHENSIVE MEDICAL CENTER I INC
Other - Org Name:DOCTORS ON CALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTTLAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-399-7328
Mailing Address - Street 1:1340 N GREAT NECK RD
Mailing Address - Street 2:SUITE 1272 PMB 390
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454
Mailing Address - Country:US
Mailing Address - Phone:757-481-5858
Mailing Address - Fax:757-481-6265
Practice Address - Street 1:1368 N GREAT NECK ROAD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454
Practice Address - Country:US
Practice Address - Phone:757-481-0303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4507400002Medicare NSC
VAC10410Medicare PIN