Provider Demographics
NPI:1972685303
Name:TIDEWATER FAMILY HEALTH CENTERS, LTD.
Entity Type:Organization
Organization Name:TIDEWATER FAMILY HEALTH CENTERS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-827-0767
Mailing Address - Street 1:2019 CUNNINGHAM DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3323
Mailing Address - Country:US
Mailing Address - Phone:757-827-0767
Mailing Address - Fax:757-838-4918
Practice Address - Street 1:2019 CUNNINGHAM DR
Practice Address - Street 2:SUITE 202
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3323
Practice Address - Country:US
Practice Address - Phone:757-827-0767
Practice Address - Fax:757-838-4918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACA9887OtherRAILROAD
VA859682OtherMAMSI
VA859682OtherUNITED HEALTHCARE
VA088742OtherBCBS
VA3036076OtherCIGNA
VA670405OtherOPTIMA
VA088742OtherBCBS
VA859682OtherMAMSI
VA=========OtherTRICARE
VA670405OtherOPTIMA