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General NPI Number Information
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NPI Number | 1346314606
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Entity Type | Individual
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Provider Name | TY SCRIVENS LSA, CSFA
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 13710 ST FRANCIS BLVD
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City | MIDLOTHIAN
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State | VA
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Zip | 23114-3267
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Country | US
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Telephone | 804-999-4354
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 HIOAKS RD UNIT 8855
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City | RICHMOND
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State | VA
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Zip | 23225-0921
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Country | US
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Telephone | 804-999-4354
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Fax | 804-965-0037
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 0136000337
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License Number State | VA
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