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General NPI Number Information
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NPI Number | 1699818237
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Entity Type | Organization
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Legal Business Name | PHYSICIANS' SURGERY CENTER OF TIDEWATER, LLC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 828 HEALTHY WAY STE 115
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-7958
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Country | US
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Telephone | 757-495-8070
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Fax | 757-495-8074
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Provider Business Mailing Address
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Address Line | 828 HEALTHY WAY STE 115
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-7958
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Country | US
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Telephone | 757-495-8070
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Fax | 757-495-8074
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | WILLIAM SCOTT MONTGOMERY
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Credential |
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Telephone | 757-495-8070
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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 | OH 708
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License Number State | VA
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