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Organization
INTREPID OF TIDEWATER, INC.
Active
Organization
INTREPID OF TIDEWATER, INC.
Active
Other names
Intrepid Palliative & Supportive Care
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT PARKER CCO (CHIEF COMPLIANCE OFFICER)
(214) 445-3750
Entity
Organization
Contact information
Practice address
101 W MAIN ST, RADFORD, VA 24141-1582
(540) 639-3280
Mailing address
3220 KELLER SPRINGS RD STE 108, CARROLLTON, TX 75006-5911
Taxonomy
Speciality
Code
Description
License number
State
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
—
NULL
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
08/05/2021
Last updated
08/05/2021
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