Provider Demographics
NPI:1861562472
Name:CITY OF VIRGINIA BEACH
Entity type:Organization
Organization Name:CITY OF VIRGINIA BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:G
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-385-0687
Mailing Address - Street 1:3432 VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4420
Mailing Address - Country:US
Mailing Address - Phone:757-385-0684
Mailing Address - Fax:757-306-5801
Practice Address - Street 1:3143 MAGIC HOLLOW BLVD STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-3077
Practice Address - Country:US
Practice Address - Phone:757-385-0687
Practice Address - Fax:757-306-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1861562472Medicaid
VA1861562472Medicaid
VA004945395Medicaid
VAC03534Medicare PIN
VA004945395OtherVA PREMIER HEALTH PLAN