Provider Demographics
NPI:1174803514
Name:TIDINGS OUT OF THE EAST INC.
Entity type:Organization
Organization Name:TIDINGS OUT OF THE EAST INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:MYERS
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-BC, FNP-BC
Authorized Official - Phone:540-222-0869
Mailing Address - Street 1:5713 HARWICH CT APT 133
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-5713
Mailing Address - Country:US
Mailing Address - Phone:540-222-0869
Mailing Address - Fax:202-683-7012
Practice Address - Street 1:5713 HARWICH CT APT 133
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-5713
Practice Address - Country:US
Practice Address - Phone:540-222-0869
Practice Address - Fax:202-683-7012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care