Provider Demographics
NPI:1528601788
Name:ULTIMATE CLINIC LLC
Entity Type:Organization
Organization Name:ULTIMATE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-537-6050
Mailing Address - Street 1:1437 SAMS DR STE 122
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4587
Mailing Address - Country:US
Mailing Address - Phone:757-537-6050
Mailing Address - Fax:
Practice Address - Street 1:1437 SAMS DR STE 122
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4587
Practice Address - Country:US
Practice Address - Phone:757-537-6050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care