Healthcare Provider Details

I. General information

NPI: 1528027026
Provider Name (Legal Business Name): VIRGINIA BEACH AMBULATORY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WILL O WISP DR
VIRGINIA BEACH VA
23454-3164
US

IV. Provider business mailing address

1700 WILL O WISP DR
VIRGINIA BEACH VA
23454-3164
US

V. Phone/Fax

Practice location:
  • Phone: 757-496-6400
  • Fax: 757-496-3137
Mailing address:
  • Phone: 757-496-6400
  • Fax: 757-496-3137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOH681
License Number StateVA

VIII. Authorized Official

Name: MARTHA COLEN
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 757-496-6400