# ISC PORTSMOUTH HEALTH SERVICES DIVISION USCG

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ISC Portsmouth Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417007790
- **Authorized official:** DR. MICHAEL J CRISTY DDS (CHIEF, HEALTH SERVICES DIVISION)
- **Authorized official phone:** (757) 483-8686

## Contact information

- **Practice address:** 4000 COAST GUARD BLVD, PORTSMOUTH, VA 23703-2199
- **Practice address phone:** (757) 483-8597
- **Practice address fax:** (757) 483-8610
- **Mailing address:** 4000 COAST GUARD BLVD, PORTSMOUTH, VA 23703-2199
- **Mailing address phone:** (757) 483-8597
- **Mailing address fax:** (757) 483-8610

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1100X | Military/U.S. Coast Guard Outpatient Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/11/2007
- **Last updated:** 08/22/2020