Healthcare Provider Details

I. General information

NPI: 1992380216
Provider Name (Legal Business Name): WEST END SURGICAL ASSISTANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 SKIPWITH RD
HENRICO VA
23229-5205
US

IV. Provider business mailing address

10604 CUSSONS RD
GLEN ALLEN VA
23060-2634
US

V. Phone/Fax

Practice location:
  • Phone: 229-569-5096
  • Fax:
Mailing address:
  • Phone: 229-569-5096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL HORNE
Title or Position: LICENSED SURGICAL ASSISTANT
Credential: CSFA, LSA
Phone: 229-569-5096