| NPI | 1366332058 |
|---|---|
| Other Name | MEDICARE PROGRAM PROVIDER |
| Entity Type | Organization |
| Authorized Contact | LAURA N MEADOWS Organizational Provider 757-698-1379 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2025-07-07 |
| Last Update Date | 2025-07-07 |