Healthcare Provider Details

I. General information

NPI: 1366496143
Provider Name (Legal Business Name): VIRGINIA SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CORPORATE BLVD
NORFOLK VA
23502-4900
US

IV. Provider business mailing address

15933 CLAYTON RD STE 210
BALLWIN MO
63011-2172
US

V. Phone/Fax

Practice location:
  • Phone: 757-965-4205
  • Fax: 757-961-2974
Mailing address:
  • Phone: 636-200-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOH699
License Number StateVA

VIII. Authorized Official

Name: JOSEPH PRAVOOT GIRA
Title or Position: CMO
Credential:
Phone: 314-909-0633