Basic Information
| Provider Information | |||||||||
| NPI: | 1841733193 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VIRGINIA HOSPITAL CENTER PHYSICIAN GROUP LLC | ||||||||
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| OtherOrganizationName: | VIRGINIA HOSPITAL CENTER PHYSICIAN GROUP-CARDIOVASCULAR AND THORACIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1715 N GEORGE MASON DR STE 409 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222053665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037177100 | ||||||||
| FaxNumber: | 7037177325 | ||||||||
| Practice Location | |||||||||
| Address1: | 1625 N GEORGE MASON DR STE 288 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222053683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035586491 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2016 | ||||||||
| LastUpdateDate: | 01/18/2019 | ||||||||
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| AuthorizedOfficialLastName: | KANE | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
| AuthorizedOfficialMiddleName: | JEANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE VP/ EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7035585000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.