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
—
—
Other
Enumeration date
09/17/2018
Last updated
09/17/2018
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