| Western Tidewater Community Services Board | |
|
7025 Harbour View Blvd Ste 119 Suffolk VA 23435-2762 | |
| (757) 966-2805 | |
| (757) 673-2586 |
| Full Name | Western Tidewater Community Services Board |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 7025 Harbour View Blvd Ste 119, Suffolk, Virginia |
| Authorized Official Name and Position | Demetrios Nicholas Peratsakis (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7573772397 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Western Tidewater Community Services Board 7025 Harbour View Blvd Ste 119 Suffolk VA 23435-2762 Ph: (757) 966-2805 | Western Tidewater Community Services Board 7025 Harbour View Blvd Ste 119 Suffolk VA 23435-2762 Ph: (757) 966-2805 |
| NPI Number | 1245082270 |
|---|---|
| Provider Enumeration Date | 04/03/2024 |
| Last Update Date | 04/03/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245082270 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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