MEDICARE: VIRGINIA SURGICAL CARE CENTER PC

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	208600000X	Surgery Physician	0101242063	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1972543650	OTHER	VA	PROVIDER NPI

General Provider Information

NPI Number	:	1891088449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA SURGICAL CARE CENTER PC

Provider Business Mailing Address
First Line	:	PO BOX 11768
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-0168
Country	:	US
Telephone Number	:	804-353-4000
Fax Number	:	804-213-9783

Provider Business Practice Location Address
First Line	:	16021 KAIROS RD
Second Line	:	SUITE A
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-5205
Country	:	US
Telephone Number	:	804-931-7720
Fax Number	:	804-451-1852

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MURALIDHARAN R BASKER
Credential	:	MD
Telephone Number	:	804-931-7720

Provider Enumeration Date	:	05/16/2011
Last Update Date	:	08/01/2011

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