Basic Information
| Provider Information | |||||||||
| NPI: | 1588608145 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUFFOLK ANESTHESIA ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 PITCHKETTLE POINT DR | ||||||||
| Address2: | |||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234347551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575461126 | ||||||||
| FaxNumber: | 7579530871 | ||||||||
| Practice Location | |||||||||
| Address1: | SENTARA OBICI HOSPITAL 2800 GODWIN BLVD | ||||||||
| Address2: | ANESTHESIA DEPARTMENT | ||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579344780 | ||||||||
| FaxNumber: | 7574837726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SPRUIELL | ||||||||
| AuthorizedOfficialFirstName: | LINWOOD | ||||||||
| AuthorizedOfficialMiddleName: | RAY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7574837706 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 001866 | VA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.