Update this page – If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS.
Organization
TIDEWATER MEDICAL SUPPLY, INC
Active
Organization
TIDEWATER MEDICAL SUPPLY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH ANTHONY DAVIES (PRESIDENT)
(757) 548-9999
Entity
Organization
Contact information
Practice address
525 BYRON ST, SUITE A, CHESAPEAKE, VA 23320-7967
(757) 548-9999
(757) 549-7752
Mailing address
525 BYRON ST, SUITE A, CHESAPEAKE, VA 23320-7967
(757) 548-9999
(757) 549-7752
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0206009115
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009117920
—
VA
01
—
1258980001
MEDICARE PARTICIPATING PROVIDER ID # 1258980001 STATE VA PTAN #
VA
Enumeration date
09/17/2006
Last updated
03/11/2010
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up