Organization
CONVENIENT CARE OF TIDEWATER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY A MORRIS MD (PRESIDENT)
(757) 549-0222
Entity
Organization
Contact information
Practice address
113 GAINSBOROUGH SQ, SUITE 103, CHESAPEAKE, VA 23320-1713
(757) 549-0222
Mailing address
PO BOX 2518, CHESAPEAKE, VA 23327-2518
(757) 549-0222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101050282
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004520572
AETNA
VA
05
—
010041741
—
VA
01
—
104078
ANTHEM
VA
01
—
72637
OPTIMA
VA
01
—
MEDCO
75063
VA
Enumeration date
11/12/2006
Last updated
01/08/2008
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