1518873207 NPI number — SHORT PUMP CV AMBULATORY SURGERY CENTER LLC

Table of content: (NPI 1518873207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518873207 NPI number — SHORT PUMP CV AMBULATORY SURGERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHORT PUMP CV AMBULATORY SURGERY CENTER LLC
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:
6
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:
1518873207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4140 PARKLAKE AVE STE 510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27612-3742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4221 BON SECOURS PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HENRICO
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-396-9391
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2026

Additional Information

Authorized Official

Authorized Official Last Name:
KLINE
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
TOMLINSON
Authorized Official Title or Position:
SENIOR VICE PRESIDENT OF OPERATIONS
Authorized Official Telephone Number:
303-396-9391

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com