1154323988 NPI number — CENTRAL VIRGINIA SURGI-CENTER LP

Table of content: (NPI 1154323988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154323988 NPI number — CENTRAL VIRGINIA SURGI-CENTER LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL VIRGINIA SURGI-CENTER LP
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:
SURGI-CENTER OF CENTRAL VIRGINIA
Provider Other Organization Name Type Code:
3
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:
1154323988
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 DIXON ST
Provider Second Line Business Mailing Address:
STE 101, MAILBOX 1
Provider Business Mailing Address City Name:
FREDERICKSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22401-7231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-371-5349
Provider Business Mailing Address Fax Number:
540-373-1745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 DIXON ST
Provider Second Line Business Practice Location Address:
STE 101, MAILBOX 1
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22401-7231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-371-5349
Provider Business Practice Location Address Fax Number:
540-373-1745
Provider Enumeration Date:
08/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ELLINGER
Authorized Official First Name:
KENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
540-371-5349

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  OH 674 , 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: 007604050 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 437844 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 62413 . This is a "FIRST HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1039920 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 34196 . This is a "APPEX BENEFIT SERVICE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 437844 . This is a "OPTIMUM CHOICE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 8561085 . This is a "AETNA PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 87726A . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 437844 . This is a "MDIPA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 437844 . This is a "ALLIANCE PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 95226 . This is a "HARRINGTON BENEFIT SERV" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 442252 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 490005350 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62413 . This is a "MAIL HANDLERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P00148932 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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