| Your Business Ccc | |
|
424 Market St Ste 100 Suffolk VA 23434-5249 | |
| (757) 347-0703 | |
| (757) 276-6514 |
| Full Name | Your Business Ccc |
|---|---|
| Speciality | Nurse Practitioner - Primary Care |
| Location | 424 Market St Ste 100, Suffolk, Virginia |
| Authorized Official Name and Position | Whitney Smith (CEO) |
| Authorized Official Contact | 7573470703 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Your Business Ccc 424 Market St Ste 100 Suffolk VA 23434-5249 Ph: (757) 347-0703 | Your Business Ccc 424 Market St Ste 100 Suffolk VA 23434-5249 Ph: (757) 347-0703 |
| NPI Number | 1639987530 |
|---|---|
| Provider Enumeration Date | 12/23/2024 |
| Last Update Date | 03/20/2025 |
| Certification Date | 03/20/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639987530 | NPI | - | NPPES |
| 1922695592 | Medicaid | VA |
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