Provider Demographics
NPI:1356716856
Name:SEASIDE THE HEALTH CENTER AT
Entity type:Organization
Organization Name:SEASIDE THE HEALTH CENTER AT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR MEDICAL BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA ROSENBAUGH
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSENBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-716-2065
Mailing Address - Street 1:1200 ATLANTIC SHORES DR
Mailing Address - Street 2:WELLNESS CLINIC
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-7311
Mailing Address - Country:US
Mailing Address - Phone:757-716-2065
Mailing Address - Fax:757-716-2019
Practice Address - Street 1:1200 ATLANTIC SHORES DR
Practice Address - Street 2:WELLNESS CLINIC
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-7311
Practice Address - Country:US
Practice Address - Phone:757-716-2065
Practice Address - Fax:757-716-2019
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEASIDE THE HEALTH CENTER AT ATLANTIC SHORES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-09
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty