Provider Demographics
NPI:1750044095
Name:ANSIBLEHEALTH INC.
Entity Type:Organization
Organization Name:ANSIBLEHEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MING JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:PO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-577-2338
Mailing Address - Street 1:249 CENTRAL PARK AVE STE 300-55
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3099
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:249 CENTRAL PARK AVE STE 300-55
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3099
Practice Address - Country:US
Practice Address - Phone:718-577-2338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center