Provider Demographics
NPI: | 1629307632 |
---|---|
Name: | CREATIVE MEDICAL INSTITUTE, LTD. |
Entity Type: | Organization |
Organization Name: | CREATIVE MEDICAL INSTITUTE, LTD. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CHRISTINE |
Authorized Official - Middle Name: | FORSYTH |
Authorized Official - Last Name: | VAN VLEEK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 757-490-9311 |
Mailing Address - Street 1: | 5589 GREENWICH RD |
Mailing Address - Street 2: | 175 |
Mailing Address - City: | VIRGINIA BEACH |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23462-6565 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 757-490-9311 |
Mailing Address - Fax: | 757-490-9266 |
Practice Address - Street 1: | 5589 GREENWICH RD |
Practice Address - Street 2: | 175 |
Practice Address - City: | VIRGINIA BEACH |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23462-6565 |
Practice Address - Country: | US |
Practice Address - Phone: | 757-490-9311 |
Practice Address - Fax: | 757-490-9266 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-12-22 |
Last Update Date: | 2009-12-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Single Specialty |