Provider Demographics
NPI:1740597202
Name:NEXT STEP MEDICAL CORP
Entity type:Organization
Organization Name:NEXT STEP MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:757-802-3210
Mailing Address - Street 1:4501 N WITCHDUCK RD STE H
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6217
Mailing Address - Country:US
Mailing Address - Phone:757-802-3210
Mailing Address - Fax:866-421-0397
Practice Address - Street 1:4501 N WITCHDUCK RD STE H
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455
Practice Address - Country:US
Practice Address - Phone:757-802-3210
Practice Address - Fax:866-421-0397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-06
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA246821-R332B00000X
VA2018-2468-21-R335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1740597202OtherTRICARE PRIME
VA1740597202Medicaid
VAP35205OtherHOMELINK
VA423608OtherANTHEM