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Organization
WESTERN TIDEWATER FREE CLINIC INC
Active
Organization
WESTERN TIDEWATER FREE CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHESTER MARVIN HART (EXECUTIVE DIRECTOR)
(757) 923-1060
Entity
Organization
Contact information
Practice address
2019 MEADE PKWY, SUFFOLK, VA 23434-4259
(757) 923-1060
(757) 923-1068
Mailing address
2019 MEADE PKWY, SUFFOLK, VA 23434-4259
(757) 923-1060
(757) 923-1068
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
09/17/2018
Last updated
09/17/2018
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