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12720 Mcmanus Blvd Ste 313 Newport News VA 23602-4414 | |
| (757) 947-3190 | |
| (757) 947-3195 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 12720 Mcmanus Blvd Ste 313, Newport News, Virginia |
| Authorized Official Name and Position | Kimberly M Ralston (SYSTEM DIRECTOR) |
| Authorized Official Contact | 4199965119 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
8580 Magellan Pkwy Richmond VA 23227-1149 Ph: (804) 627-5462 | 12720 Mcmanus Blvd Ste 313 Newport News VA 23602-4414 Ph: (757) 947-3190 |
| NPI Number | 1013439835 |
|---|---|
| Provider Enumeration Date | 07/13/2017 |
| Last Update Date | 11/04/2024 |
| Medicare PECOS PAC ID | 5799685632 |
|---|---|
| Medicare Enrollment ID | O20040108001176 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013439835 | NPI | - | NPPES |
| C05149 | Other | VA | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Mitchell Shiffman |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1497847461 PECOS PAC ID: 2163561416 Enrollment ID: I20091130000540 |
| Provider Name | Philip C Alexander |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578860607 PECOS PAC ID: 0840476560 Enrollment ID: I20110513000589 |
| Provider Name | Karla M Pray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801153531 PECOS PAC ID: 9234385303 Enrollment ID: I20120804000145 |
| Provider Name | Margaret Aston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770057069 PECOS PAC ID: 6608289004 Enrollment ID: I20210104000328 |
Peninsula Institute For Community Health Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1033 28th St, 2nd Floor, Newport News, VA 23607 Phone: 757-591-0643 Fax: 757-591-0682 | |
Riverside Hospital Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 856 J Clyde Morris Blvd, Suite A, Newport News, VA 23601 Phone: 757-594-4006 Fax: 757-534-5190 | |