MEDICARE: BUSCH GARDENS WILLIAMSBURG

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	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1386934586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUSCH GARDENS WILLIAMSBURG

Provider Business Mailing Address
First Line	:	1 BUSCH GARDENS BLVD
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-5664
Country	:	US
Telephone Number	:	757-253-3554
Fax Number	:	757-253-3032

Provider Business Practice Location Address
First Line	:	1 BUSCH GARDENS BLVD
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-5664
Country	:	US
Telephone Number	:	757-253-3554
Fax Number	:	757-253-3032

Authorized Official
Title or Position	:	HEALTH SERVICES MANGER
Name	:	GREGORY COFFMAN
Credential	:	RN
Telephone Number	:	757-253-3554

Provider Enumeration Date	:	04/10/2011
Last Update Date	:	04/10/2011

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