Provider Demographics
NPI:1568621787
Name:U S NAVY
Entity Type:Organization
Organization Name:U S NAVY
Other - Org Name:NAVAL MEDICAL CENTER PORTSMOUTH VA
Other - Org Type:Other Name
Authorized Official - Title/Position:INDEPENDENT DUTY CORPSMAN
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:FLINT
Authorized Official - Suffix:
Authorized Official - Credentials:IDC
Authorized Official - Phone:757-953-3774
Mailing Address - Street 1:1550 TOMCAT BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23460-2218
Mailing Address - Country:US
Mailing Address - Phone:757-953-3774
Mailing Address - Fax:
Practice Address - Street 1:1550 TOMCAT BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23460-2218
Practice Address - Country:US
Practice Address - Phone:757-953-3774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA