| Spora Medical, Pc. | |
|
4445 Corporation Ln Ste 264 Virginia Beach VA 23462-3262 | |
| (773) 389-1899 | |
| (773) 466-9777 |
| Full Name | Spora Medical, Pc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 4445 Corporation Ln Ste 264, Virginia Beach, Virginia |
| Authorized Official Name and Position | Lakisa Davis (COM) |
| Authorized Official Contact | 7733891899 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spora Medical, Pc. 4445 Corporation Ln Ste 264 Virginia Beach VA 23462-3262 Ph: (773) 389-1899 | Spora Medical, Pc. 4445 Corporation Ln Ste 264 Virginia Beach VA 23462-3262 Ph: (773) 389-1899 |
| NPI Number | 1922695949 |
|---|---|
| Provider Enumeration Date | 12/23/2020 |
| Last Update Date | 06/11/2022 |
| Medicare PECOS PAC ID | 3072906064 |
|---|---|
| Medicare Enrollment ID | O20220216000842 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922695949 | NPI | - | NPPES |
| 1922695949 | Other | NPI |
| Provider Name | Craig S Coleman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659622777 PECOS PAC ID: 2961724638 Enrollment ID: I20141208001735 |
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