1558407338 NPI number — VIRGINIA THORACIC SURGERY, INC

Table of content: (NPI 1558407338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558407338 NPI number — VIRGINIA THORACIC SURGERY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIRGINIA THORACIC SURGERY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558407338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2004 BREMO RD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23226-2442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-565-0383
Provider Business Mailing Address Fax Number:
804-565-0389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2004 BREMO RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23226-2442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-565-0383
Provider Business Practice Location Address Fax Number:
804-565-0389
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BUCKMAN
Authorized Official First Name:
PETER
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER, PRESIDENT
Authorized Official Telephone Number:
804-565-0383

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  0101052545 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com