Healthcare Provider Details

I. General information

NPI: 1073807376
Provider Name (Legal Business Name): SURGERY CENTER ANESTHESIA PROVIDERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 MONTICELLO AVE
WILLIAMSBURG VA
23188-8232
US

IV. Provider business mailing address

7269 TROTTERS RUN
TRINITY NC
27370-7394
US

V. Phone/Fax

Practice location:
  • Phone: 757-229-4000
  • Fax: 952-442-3620
Mailing address:
  • Phone: 800-204-0099
  • Fax: 336-882-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL LECATES
Title or Position: OWNER
Credential: CRNA
Phone: 336-420-7472