Provider Demographics
NPI:1639314370
Name:SOUTH NORFOLK MEDICAL SERVICES,LLC
Entity Type:Organization
Organization Name:SOUTH NORFOLK MEDICAL SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-485-9870
Mailing Address - Street 1:1201 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23324-2307
Mailing Address - Country:US
Mailing Address - Phone:757-545-0425
Mailing Address - Fax:757-545-0426
Practice Address - Street 1:1201 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-2307
Practice Address - Country:US
Practice Address - Phone:757-545-0425
Practice Address - Fax:757-545-0426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043479261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care