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General NPI Number Information
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NPI Number | 1447046586
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Entity Type | Organization
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Legal Business Name | PENINSULA ASC, LLC
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 580 CITY CENTER BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-1880
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Country | US
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Telephone | 757-596-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 580 CITY CENTER BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-1880
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Country | US
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Telephone | 757-596-1900
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Fax |
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Authorized Official
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Title or Position | VP REIMBURSEMENT
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Name | KIMBERLY M RALSTON
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Credential |
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Telephone | 419-996-5119
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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 |
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License Number State |
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