Provider Demographics
NPI:1083019335
Name:HEALTH HERO MID-ATLANTIC, LLC
Entity Type:Organization
Organization Name:HEALTH HERO MID-ATLANTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-869-4983
Mailing Address - Street 1:10 ISLAND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-7471
Mailing Address - Country:US
Mailing Address - Phone:757-869-4983
Mailing Address - Fax:
Practice Address - Street 1:10 ISLAND VIEW DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-7471
Practice Address - Country:US
Practice Address - Phone:757-869-4983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH HERO USA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-29
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty