Provider Demographics
NPI:1518901339
Name:JILL T FLOOD MD
Entity Type:Organization
Organization Name:JILL T FLOOD MD
Other - Org Name:BEACH CENTER FOR INFERTILITY
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:757-428-0002
Mailing Address - Street 1:844 FIRST COLONIAL RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451
Mailing Address - Country:US
Mailing Address - Phone:757-428-0002
Mailing Address - Fax:757-428-4555
Practice Address - Street 1:844 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 202
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451
Practice Address - Country:US
Practice Address - Phone:757-428-0002
Practice Address - Fax:757-428-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006259979Medicaid
VA160000809Medicare PIN
VA006259979Medicaid