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108 Knells Ridge Blvd Suite 108 Chesapeake VA 23320-4885 | |
(757) 436-1234 | |
(757) 548-3665 |
Full Name | |
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Speciality | Family Medicine |
Location | 108 Knells Ridge Blvd, Chesapeake, Virginia |
Authorized Official Name and Position | Ronald Atwood (PRESIDENT) |
Authorized Official Contact | 7574361234 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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108 Knells Ridge Blvd Suite 108 Chesapeake VA 23320-4885 Ph: (757) 436-1234 | 108 Knells Ridge Blvd Suite 108 Chesapeake VA 23320-4885 Ph: (757) 436-1234 |
NPI Number | 1982637575 |
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Provider Enumeration Date | 07/08/2006 |
Last Update Date | 09/24/2008 |
Medicare PECOS PAC ID | 8123077617 |
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Medicare Enrollment ID | O20050122000012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1982637575 | NPI | - | NPPES |
091662 | Other | VA | BCBS GROUP |
CH1314 | Other | RR MCARE GROUP |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Eleanor Lynn Deguzman-berube |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1669440061 PECOS PAC ID: 2264563287 Enrollment ID: I20100708000082 |
Provider Name | Ronald Wayne Atwood |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1932177375 PECOS PAC ID: 7113976606 Enrollment ID: I20100708000093 |
Provider Name | Megan Nicole Cannon |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1871885616 PECOS PAC ID: 8325226400 Enrollment ID: I20110620000100 |
Provider Name | Jarrod Lynn Elsass |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1700328978 PECOS PAC ID: 1052693934 Enrollment ID: I20180502003017 |
Provider Name | Stephanie Danielle Hendrick |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1790241594 PECOS PAC ID: 1951642669 Enrollment ID: I20190408000150 |
Provider Name | Meagan Taylor Yauilla |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1942880414 PECOS PAC ID: 0446651996 Enrollment ID: I20210622002485 |
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