| Obici Medical Management Services, Inc. | |
|
109 Railroad Avenue Wakefield VA 23434 | |
| (757) 899-3521 | |
| (757) 899-7104 |
| Full Name | Obici Medical Management Services, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 109 Railroad Avenue, Wakefield, Virginia |
| Authorized Official Name and Position | William Carpentar (SR VP-CFO) |
| Authorized Official Contact | 7579344000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Obici Medical Management Services, Inc. 2800 Godwin Blvd Suffolk VA 23434-8038 Ph: (757) 934-4000 | Obici Medical Management Services, Inc. 109 Railroad Avenue Wakefield VA 23434 Ph: (757) 899-3521 |
| NPI Number | 1720017379 |
|---|---|
| Provider Enumeration Date | 07/03/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720017379 | NPI | - | NPPES |
| 323791 | Other | VA | ANTHEM |
| 41033 | Other | VA | OPTIMA/SENTARA |
| 263206 | Other | VA | OPTIMA MEDICAID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0101018926 (Virginia) | Primary |