1467468603 NPI number — MEMORIAL AMBULATORY SURGERY CENTER

Table of content: (NPI 1467468603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467468603 NPI number — MEMORIAL AMBULATORY SURGERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL AMBULATORY SURGERY CENTER
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:
MEMORIAL AMBULATORY SURGERY CENTER
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:
1467468603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
04/28/2011
NPI Reactivation Date:
12/29/2011

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8262 ATLEE RD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MECHANICSVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23116-1816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-746-6969
Provider Business Mailing Address Fax Number:
804-746-6950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8262 ATLEE ROAD, MOB III, SUITE #100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MECHANICSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-746-6969
Provider Business Practice Location Address Fax Number:
804-746-6950
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NUGENT
Authorized Official First Name:
DANIELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
804-287-7881

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  OH696 , 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)





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