Healthcare Provider Details

I. General information

NPI: 1902899784
Provider Name (Legal Business Name): PENINSULA ANESTHESIA CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 KINGS WAY STE 1500
WILLIAMSBURG VA
23185-2505
US

IV. Provider business mailing address

PO BOX 697
TOANO VA
23168-0697
US

V. Phone/Fax

Practice location:
  • Phone: 757-645-3216
  • Fax: 757-645-3132
Mailing address:
  • Phone: 800-919-1190
  • Fax: 706-860-6484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. GEORGE TILTON HEATH
Title or Position: PARTNER
Credential: MD
Phone: 757-645-3216