Provider Demographics
NPI:1710327267
Name:ACCESS PEDIATRIC CARE
Entity Type:Organization
Organization Name:ACCESS PEDIATRIC CARE
Other - Org Name:ACCESS PEDIATRIC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:SOVEK
Authorized Official - Last Name:CORNETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-525-2595
Mailing Address - Street 1:3021 CAMROSE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-8712
Mailing Address - Country:US
Mailing Address - Phone:757-525-2595
Mailing Address - Fax:757-273-1133
Practice Address - Street 1:3021 CAMROSE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-8712
Practice Address - Country:US
Practice Address - Phone:757-525-2595
Practice Address - Fax:757-273-1133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCESS FAMILY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001193123251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management