Provider Demographics
NPI:1144604877
Name:PORTSMOUTH COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:PORTSMOUTH COMMUNITY HEALTH CENTER INC
Other - Org Name:LITTLE CREEK FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
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:757-393-6363
Mailing Address - Street 1:644 LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704
Mailing Address - Country:US
Mailing Address - Phone:757-393-6363
Mailing Address - Fax:757-397-0047
Practice Address - Street 1:7447 CENTRAL BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2831
Practice Address - Country:US
Practice Address - Phone:757-295-8100
Practice Address - Fax:757-215-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)