Healthcare Provider Details

I. General information

NPI: 1083677595
Provider Name (Legal Business Name): HANOVER OUTPATIENT SURGERY CENTER, L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7016 LEE PARK RD
MECHANICSVILLE VA
23111-3682
US

IV. Provider business mailing address

7016 LEE PARK RD
MECHANICSVILLE VA
23111-3682
US

V. Phone/Fax

Practice location:
  • Phone: 804-730-9000
  • Fax: 804-730-1460
Mailing address:
  • Phone: 804-730-9000
  • Fax: 804-730-1460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOH657
License Number StateVA

VIII. Authorized Official

Name: DON LIEDTKE
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-344-5507