Provider Demographics
NPI:1225172810
Name:SOUTHEASTERN VIRGINIA TRAINING CENTER
Entity Type:Organization
Organization Name:SOUTHEASTERN VIRGINIA TRAINING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHREWSBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:757-424-8201
Mailing Address - Street 1:2100 STEPPINGSTONE SQUARE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320
Mailing Address - Country:US
Mailing Address - Phone:757-424-8201
Mailing Address - Fax:757-424-8348
Practice Address - Street 1:2100 STEPPINGSTONE SQ
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2517
Practice Address - Country:US
Practice Address - Phone:757-424-8201
Practice Address - Fax:757-424-8348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4966562Medicaid
VAC03185OtherTRAILBLAZERS