Provider Demographics
NPI:1154576759
Name:HAMPTON UNIVERSITY HEALTH CENTER
Entity type:Organization
Organization Name:HAMPTON UNIVERSITY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:757-727-5315
Mailing Address - Street 1:55 EAST TYLER STREET
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23668
Mailing Address - Country:US
Mailing Address - Phone:757-727-5315
Mailing Address - Fax:757-728-6612
Practice Address - Street 1:55 EAST TYLER STREET
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23668
Practice Address - Country:US
Practice Address - Phone:757-727-5315
Practice Address - Fax:757-728-6612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001068591163W00000X
VA0001048383163W00000X
VA0001056106163W00000X
VA0024164147363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty