Healthcare Provider Details

I. General information

NPI: 1568543411
Provider Name (Legal Business Name): WEST END SURGICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7702 E PARHAM RD MOB III, SUITE 102
RICHMOND VA
23294-4371
US

IV. Provider business mailing address

7702 E PARHAM RD MOB III, SUITE 102
RICHMOND VA
23294-4371
US

V. Phone/Fax

Practice location:
  • Phone: 804-346-1612
  • Fax: 804-346-1536
Mailing address:
  • Phone: 804-346-1612
  • Fax: 804-346-1536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101235753
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101046045
License Number StateVA

VIII. Authorized Official

Name: MRS. DEBRA GOULD
Title or Position: OFFICE MANAGER
Credential:
Phone: 804-346-1612