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General NPI Number Information
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NPI Number | 1205443876
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Entity Type | Organization
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Legal Business Name | BEACH SURGICAL ASSISTANTS OF VA, LLC
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 11/11/2020
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Provider Practice Location Address
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Address Line | 2233 ELDER RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-1105
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Country | US
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Telephone | 757-343-4735
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Fax |
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Provider Business Mailing Address
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Address Line | 2233 ELDER RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-1105
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Country | US
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Telephone | 757-343-4735
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Fax |
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Authorized Official
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Title or Position | SURGICAL ASSISTANT, OWNER
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Name | MRS. DEBORAH REDMOND
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Credential | CSA
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Telephone | 757-343-4735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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