1891088449 NPI number — VIRGINIA SURGICAL CARE CENTER PC

Table of content: (NPI 1891088449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891088449 NPI number — VIRGINIA SURGICAL CARE CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIRGINIA SURGICAL CARE CENTER PC
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:
1891088449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11768
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23230-0168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-353-4000
Provider Business Mailing Address Fax Number:
804-213-9783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16021 KAIROS RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
COLONIAL HEIGHTS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23834-5205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-931-7720
Provider Business Practice Location Address Fax Number:
804-451-1852
Provider Enumeration Date:
05/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BASKER
Authorized Official First Name:
MURALIDHARAN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
804-931-7720

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  0101242063 , 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)

  • Identifier: 1972543650 . This is a "PROVIDER NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com