{"npi":"1104923895","type":"NPI-2","status":"active","name":{"display":"Tidewater Medical Supply, INC","other":[],"organization_name":"TIDEWATER MEDICAL SUPPLY, INC","authorised_official":"Keith Davies"},"specialty":{"primary_taxonomy":"332BX2000X","primary_taxonomy_description":"Oxygen Equipment & Supplies (DME)","slug":"oxygen-equipment-supplies-dme","schema_org_specialty":null,"all":[{"code":"332BX2000X","description":"Oxygen Equipment & Supplies (DME)","primary":true,"state":"VA","license":"0206009115"}]},"addresses":[{"purpose":"LOCATION","street_1":"525 BYRON ST","city":"CHESAPEAKE","state":"VA","postal_code":"233207967","country_code":"US","street_2":"SUITE A","phone":"7575489999","fax":"7575497752"},{"purpose":"MAILING","street_1":"525 BYRON ST","city":"CHESAPEAKE","state":"VA","postal_code":"233207967","country_code":"US","street_2":"SUITE A","phone":"7575489999","fax":"7575497752"}],"license":{"state":"VA","number":"0206009115"},"identifiers":[{"type_code":"01","label":"Other","value":"1258980001","state":"VA","issuer":"MEDICARE PARTICIPATING PROVIDER ID # 1258980001 STATE VA PTAN #"},{"type_code":"05","label":"Medicaid","value":"009117920","state":"VA","issuer":null}],"pecos":{"enrolled_at":null,"enrollments":[]},"enumeration_date":"2006-09-17","last_updated":"2010-03-11","_meta":{"source":"NPPES","snapshot_date":"2010-03-11","doc_url":"https://findmynpi.com/api"}}