Provider Demographics
NPI:1851523112
Name:TRAVEL HEALTH OF WILLIAMSBURG, LLC
Entity Type:Organization
Organization Name:TRAVEL HEALTH OF WILLIAMSBURG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKI
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CTH
Authorized Official - Phone:757-220-9008
Mailing Address - Street 1:287 MCLAWS CIR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5872
Mailing Address - Country:US
Mailing Address - Phone:757-220-9008
Mailing Address - Fax:757-220-9027
Practice Address - Street 1:287 MCLAWS CIR
Practice Address - Street 2:SUITE 2
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5872
Practice Address - Country:US
Practice Address - Phone:757-220-9008
Practice Address - Fax:757-220-9027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center