Basic Information
| Provider Information | |||||||||
| NPI: | 1902899784 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PENINSULA ANESTHESIA CONSULTANTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 697 | ||||||||
| Address2: | |||||||||
| City: | TOANO | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231680697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009191190 | ||||||||
| FaxNumber: | 7068606484 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 KINGS WAY | ||||||||
| Address2: | STE 1500 | ||||||||
| City: | WILLIAMSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231852505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576453216 | ||||||||
| FaxNumber: | 7576453132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | HEATH | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | TILTON | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7576453216 | ||||||||
| IsSoleProprietor: | |||||||||
| 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 | 207LP2900X | VA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 367500000X | VA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | VA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.