Basic Information
| Provider Information | |||||||||
| NPI: | 1518450790 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VIRGINIA ENT SURGERY CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 36007 | ||||||||
| Address2: | |||||||||
| City: | NORTH CHESTERFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232358000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044843702 | ||||||||
| FaxNumber: | 8043206462 | ||||||||
| Practice Location | |||||||||
| Address1: | 6600 W BROAD ST STE 210 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232301709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044843700 | ||||||||
| FaxNumber: | 8043206462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2018 | ||||||||
| LastUpdateDate: | 06/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | HICKEY | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8042855907 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.