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General NPI Number Information
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NPI Number | 1083677595
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Entity Type | Organization
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Legal Business Name | HANOVER OUTPATIENT SURGERY CENTER, L.P.
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 7016 LEE PARK RD
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-3682
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Country | US
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Telephone | 804-730-9000
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Fax | 804-730-1460
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Provider Business Mailing Address
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Address Line | 7016 LEE PARK RD
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-3682
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Country | US
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Telephone | 804-730-9000
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Fax | 804-730-1460
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DON LIEDTKE
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Credential |
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Telephone | 615-344-5507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | OH657
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License Number State | VA
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