Provider Demographics
NPI:1073833760
Name:PORTSMOUTH COMMUNITY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:PORTSMOUTH COMMUNITY HEALTH CENTER, INC
Other - Org Name:PARK PLACE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-397-0042
Mailing Address - Street 1:1541 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-3209
Mailing Address - Country:US
Mailing Address - Phone:757-393-6363
Mailing Address - Fax:757-622-6384
Practice Address - Street 1:155 KINGSLEY LN STE 320
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4629
Practice Address - Country:US
Practice Address - Phone:757-533-9108
Practice Address - Fax:757-622-6384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
C06157Medicare PIN
491904Medicare Oscar/Certification