Provider Demographics
NPI:1114322732
Name:SOUTHAMPTON HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTHAMPTON HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LES
Authorized Official - Middle Name:V
Authorized Official - Last Name:GRAINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-696-0344
Mailing Address - Street 1:PO BOX 62816
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23466
Mailing Address - Country:US
Mailing Address - Phone:757-723-0252
Mailing Address - Fax:866-837-2972
Practice Address - Street 1:2112 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666
Practice Address - Country:US
Practice Address - Phone:757-723-0252
Practice Address - Fax:866-837-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Single Specialty