Provider Demographics
NPI:1346418290
Name:SPECIAL BOAT TEAM TWENTY
Entity Type:Organization
Organization Name:SPECIAL BOAT TEAM TWENTY
Other - Org Name:US NAVY
Other - Org Type:Other Name
Authorized Official - Title/Position:HMC
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:PREWITT
Authorized Official - Suffix:JR
Authorized Official - Credentials:IDC
Authorized Official - Phone:757-763-4063
Mailing Address - Street 1:2220 SCHOFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23521-2838
Mailing Address - Country:US
Mailing Address - Phone:757-763-4063
Mailing Address - Fax:
Practice Address - Street 1:2220 SCHOFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23521-2838
Practice Address - Country:US
Practice Address - Phone:757-763-4063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital