Organization
OBICI MEDICAL MANAGEMENT SERVICES, INC.
Active
Other names
Wakefield Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM CARPENTAR (SR VP-CFO)
(757) 934-4000
Entity
Organization
Contact information
Practice address
109 RAILROAD AVENUE, WAKEFIELD, VA 23434
(757) 899-3521
(757) 899-7104
Mailing address
2800 GODWIN BLVD, SUFFOLK, VA 23434-8038
(757) 934-4000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101018926
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
263206
OPTIMA MEDICAID
VA
01
—
323791
ANTHEM
VA
01
—
41033
OPTIMA/SENTARA
VA
Enumeration date
07/03/2006
Last updated
08/22/2020
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