| Organization Name: | TIDEWATER HEARING CENTER |
| NPI Number: | 1093110223 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JANET IVENS (OWNER) |
| Mailing Address: | 5200 Mercury Blvd Sears, Suite 100 Newport News |
| State: | VA US |
| Postal Code: | 236051445 |
| Phone Number: | 7578259477 |
| Fax Number: | |
| NPI Enumeration Date: | 10/30/2014 |
| NPI Last Update Date: | 10/31/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 03231 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |