Provider Demographics
NPI:1659441814
Name:NORFOLK COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:NORFOLK COMMUNITY HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:ADM
Authorized Official - Phone:757-623-0095
Mailing Address - Street 1:1401 TIDEWATER DRIVE
Mailing Address - Street 2:STE 1
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504
Mailing Address - Country:US
Mailing Address - Phone:757-623-0095
Mailing Address - Fax:757-623-1203
Practice Address - Street 1:1401 TIDEWATER DRIVE
Practice Address - Street 2:STE 1
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504
Practice Address - Country:US
Practice Address - Phone:757-623-0095
Practice Address - Fax:757-623-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902199Medicaid
VA176497OtherANTHEM
VA131851OtherOPTIMA
VAC09539Medicare ID - Type Unspecified
NC5902199Medicaid