Provider Demographics
NPI:1497740708
Name:PATIENT CHOICE GHENT
Entity Type:Organization
Organization Name:PATIENT CHOICE GHENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:CARETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-425-8590
Mailing Address - Street 1:1232 PERIMETER PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5689
Mailing Address - Country:US
Mailing Address - Phone:757-425-8590
Mailing Address - Fax:757-422-5107
Practice Address - Street 1:957E WEST 21ST ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1536
Practice Address - Country:US
Practice Address - Phone:757-622-8358
Practice Address - Fax:757-622-9662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
C05646Medicare PIN