1124036843 NPI number — COSMETIC SURGERY CENTER FOR WOMEN

Table of content: (NPI 1124036843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124036843 NPI number — COSMETIC SURGERY CENTER FOR WOMEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COSMETIC SURGERY CENTER FOR WOMEN
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:
1124036843
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:
396 SOUTH WITCHDUCK RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-497-5400
Provider Business Mailing Address Fax Number:
757-497-8811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
396 SOUTH WITCHDUCK RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-497-5400
Provider Business Practice Location Address Fax Number:
757-497-8811
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOPES
Authorized Official First Name:
JOANN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
757-497-5400

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  0101051490 , 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: 0101051490 . This is a "LICENSE #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 218188 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1300214 . This is a "UHUH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 218188 . This is a "BCFED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 218188 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 218188 . This is a "BCBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 38420 . This is a "SHSOPTIMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5158493 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 218188 . This is a "BCHKP" identifier . This identifiers is of the category "OTHER".




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