Organization
TIDEWATER ORTHOPAEDIC ASSOCIATES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY TANNER BELL (CEO)
(757) 827-2480
Entity
Organization
Contact information
Practice address
901 ENTERPRISE PKWY STE 900, HAMPTON, VA 23666-6250
(757) 827-2480
(757) 827-2566
Mailing address
901 ENTERPRISE PARKWAY, SUITE 900, HAMPTON, VA 23666
(757) 827-2480
(757) 282-5848
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
78013
VA
261QP2000X
Physical Therapy Clinic/Center
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
192680
ANTHEM OT GROUP#
VA
05
—
3001514667-0001
—
VA
05
—
3001514667-0004
—
VA
05
—
3001514667-0005
—
VA
01
—
371277300
US DEPT OF LABOR GROUP#
—
01
—
453382
ANTHEM GROUP NUMBER
VA
01
—
463139
ANTHEM PT GROUP NUMBER
VA
01
—
500002
SENTARA VENDER NUMBER
VA
01
—
64835
SENTARA THERAPY GROUP#
VA
01
—
CF1964
MEDICARE RR GROUP NUMBER
—
Enumeration date
07/20/2006
Last updated
03/22/2024
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