| Bhg Xlii, Llc | |
|
5715 Princess Anne Rd Virginia Beach VA 23462-3222 | |
| (757) 962-0748 | |
| Not Available |
| Full Name | Bhg Xlii, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5715 Princess Anne Rd, Virginia Beach, Virginia |
| Authorized Official Name and Position | Jemece Michelle Gasaway (DIRECTOR OF LICENSING) |
| Authorized Official Contact | 2143656126 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bhg Xlii, Llc 5001 Spring Valley Rd Suite 600 East Dallas TX 75244-3946 Ph: (214) 365-6100 | Bhg Xlii, Llc 5715 Princess Anne Rd Virginia Beach VA 23462-3222 Ph: (757) 962-0748 |
| NPI Number | 1003362484 |
|---|---|
| Provider Enumeration Date | 08/26/2016 |
| Last Update Date | 02/22/2019 |
| Medicare PECOS PAC ID | 3779867049 |
|---|---|
| Medicare Enrollment ID | O20170306000709 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003362484 | NPI | - | NPPES |
| Provider Name | Kenneth B Brown |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1164521084 PECOS PAC ID: 6305824293 Enrollment ID: I20070411000272 |
| Provider Name | Brian P Murray |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1831233873 PECOS PAC ID: 8325268410 Enrollment ID: I20160223002348 |
| Provider Name | Craig W Swainey |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1437367414 PECOS PAC ID: 9436213634 Enrollment ID: I20160622002301 |
| Provider Name | Rose M. Jacques |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871041376 PECOS PAC ID: 1557642477 Enrollment ID: I20170106001313 |
| Provider Name | Julian S Ku |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1922386291 PECOS PAC ID: 8224312434 Enrollment ID: I20170308000869 |
| Provider Name | Noelle S Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649766569 PECOS PAC ID: 3678817913 Enrollment ID: I20181127003294 |
| Provider Name | Maria N Amadi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881155109 PECOS PAC ID: 0749699304 Enrollment ID: I20210511002228 |
| Provider Name | Kristina E Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801444377 PECOS PAC ID: 2961811435 Enrollment ID: I20210513000850 |
| Provider Name | Latoya Price |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578120358 PECOS PAC ID: 6800200916 Enrollment ID: I20210520000002 |
| Provider Name | Iris Catherine Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043828874 PECOS PAC ID: 7214336353 Enrollment ID: I20210524000279 |
| Provider Name | Alecia Sheree Ball |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558906313 PECOS PAC ID: 6204235229 Enrollment ID: I20210525001059 |
| Provider Name | Veronica Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760052146 PECOS PAC ID: 6507263811 Enrollment ID: I20210928003323 |
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