Organization
IPS OF TIDEWATER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL R NOBACK MD (MEDICAL DIRECTOR)
(888) 337-3509
Entity
Organization
Contact information
Practice address
112 GAINSBOROUGH SQ, SUITE 200, CHESAPEAKE, VA 23320-1706
(757) 547-0798
(757) 547-0145
Mailing address
PO BOX 864820, ORLANDO, FL 32886-0001
(888) 337-3509
(941) 328-3997
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
06/05/2012
Last updated
06/05/2012
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