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WESTERN TIDEWATER FREE CLINIC INC
NPI 1295219210
General Practice in Suffolk, VA

Active since September 17, 2018CLIA 49D1076912 · Waiver
2019 MEADE PKWY, SUFFOLK, VA 23434(757) 923-1060(757) 923-1068 Get Directions Write a Review

NPPES record last updated: September 17, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Western Tidewater Free Clinic Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WESTERN TIDEWATER FREE CLINIC INC (NPI 1295219210) is a healthcare organization registered as a general practice in Suffolk, Virginia and active in the NPI registry since September 2018. The organization holds a CLIA Waiver certificate valid through November 27, 2027 and lists Chester Marvin Hart, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1295219210
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameWESTERN TIDEWATER FREE CLINIC INC
Location Address2019 MEADE PKWYSuffolk, VA 23434-4259
Mailing Address2019 Meade PkwySuffolk, VA 23434-4259 · (757) 923-1060 · Fax (757) 923-1068
Phone(757) 923-1060
Fax(757) 923-1068
Organization SubpartNo
Authorized OfficialChester Marvin HartExecutive Director · (757) 923-1060
Enumeration DateSeptember 17, 2018
✔ NPI 1295219210 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
2019 MEADE PKWY, Suffolk, VA 23434
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D1076912

Western Tidewater Free Clinic · Suffolk, VA
Active · expires Nov 27, 2027
CLIA Number49D1076912
Laboratory TypeOther
Certificate Effective DateNovember 28, 2025
Certificate Expiration DateNovember 27, 2027
Laboratory DirectorDaniel Garland, MD
Laboratory Phone(757) 923-1060
Laboratory LocationWestern Tidewater Free Clinic2019 Meade Parkway Attn Pamela Witt, Suffolk, VA 23434
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LINDA KAY FREY N.P.
Family Medicine
2019 MEADE PKWY
SUFFOLK, VA 23434
Suffolk City (757) 923-1060
NANCY CROWDER ROGERSON RPH
Pharmacist
2019 MEADE PKWY
SUFFOLK, VA 23434
Suffolk City (757) 675-6561

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Western Tidewater Free Clinic Inc's NPI number?

The NPI number for Western Tidewater Free Clinic Inc is 1295219210. It was assigned to this organization in the NPPES registry on September 17, 2018.

Where is Western Tidewater Free Clinic Inc located?

Western Tidewater Free Clinic Inc is located at 2019 Meade Pkwy, Suffolk, VA 23434. The listed phone number is (757) 923-1060.

What is Western Tidewater Free Clinic Inc's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Does Western Tidewater Free Clinic Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D1076912) is associated with this NPI, valid through November 27, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Western Tidewater Free Clinic Inc was last updated on September 17, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.