Healthcare Provider Details

I. General information

NPI: 1720190119
Provider Name (Legal Business Name): AUGUSTA SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 IVY RIDGE LN STE 130
FISHERSVILLE VA
22939-2354
US

IV. Provider business mailing address

16 IVY RIDGE LN STE 130
FISHERSVILLE VA
22939-2354
US

V. Phone/Fax

Practice location:
  • Phone: 540-332-5909
  • Fax: 540-332-5910
Mailing address:
  • Phone: 540-332-5909
  • Fax: 540-332-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA M MCKIBBIN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 540-332-5909