MEDICARE: MR. TY SCRIVENS LSA, CSFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	0136000337	VA

General Provider Information

NPI Number	:	1346314606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TY SCRIVENS LSA, CSFA

Provider Business Mailing Address
First Line	:	1021 HIOAKS RD UNIT 8855
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-0921
Country	:	US
Telephone Number	:	804-999-4354
Fax Number	:	804-965-0037

Provider Business Practice Location Address
First Line	:	1021 HIOAKS RD UNIT 8855
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-0921
Country	:	US
Telephone Number	:	804-999-4354
Fax Number	:	804-965-0037

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	01/23/2026

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