OrganizationTidewater Internal Medicine Associates, P.C.Internal MedicineAllopathic & Osteopathic PhysiciansPractice Address2115 Executive Dr, Suite 4-B, Hampton, VA 23666-2499(757) 838-2891(804) 353-4000PECOS EnrollmentBased on the most recent information from CMS, provider Tidewater Internal Medicine Associates, P.C. does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:47 AM.Profile DetailsProvider ID1639138365Provider TypeOrganizationFull NameTidewater Internal Medicine Associates, P.C.SubpartNoEnumeration Date3/21/2006Last Updated8/22/2020Contact InformationPractice LocationPractice Address2115 Executive Dr, Suite 4-B, Hampton, VA 23666-2499Phone(757) 838-2891Fax(757) 838-6108Mailing LocationMailing AddressPO Box 11768, Richmond, VA 23230-0168Phone(804) 353-4000Fax(804) 213-9783Authorized OfficialNameChinnery, Lind W. (President)Phone(757) 838-2891Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerIDC05867DescriptionOtherIssuerMEDICARE GROUP NUMBER