Basic Information
| Provider Information | |||||||||
| NPI: | 1104342740 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JVH SURGICAL ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 MAGNOLIA GLN APT 102 | ||||||||
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| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224018902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082303933 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8118 GOOD LUCK RD | ||||||||
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| City: | LANHAM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207063574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015528118 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2017 | ||||||||
| LastUpdateDate: | 10/18/2017 | ||||||||
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| AuthorizedOfficialLastName: | LUNA | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8082303933 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CSFA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.