Provider Demographics
NPI:1467589234
Name:SENTARA HOSPITALS
Entity Type:Organization
Organization Name:SENTARA HOSPITALS
Other - Org Name:SENTARA CAREPLEX HOSPITAL OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-455-7020
Mailing Address - Street 1:3000 COLISEUM DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5963
Mailing Address - Country:US
Mailing Address - Phone:757-736-1200
Mailing Address - Fax:757-736-1250
Practice Address - Street 1:3000 COLISEUM DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5963
Practice Address - Country:US
Practice Address - Phone:757-736-1200
Practice Address - Fax:757-736-1250
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENTARA HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-27
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
VA02010035783336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008519897Medicaid