MEDICARE: PENINSULA ANESTHESIA CONSULTANTS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	VA
2	367500000X	Certified Registered Nurse Anesthetist	VA
3	207L00000X	Anesthesiology Physician	VA

General Provider Information

NPI Number	:	1902899784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENINSULA ANESTHESIA CONSULTANTS LLC

Provider Business Mailing Address
First Line	:	PO BOX 697
Second Line	:
City	:	TOANO
State	:	VA
Zip	:	23168-0697
Country	:	US
Telephone Number	:	800-919-1190
Fax Number	:	706-860-6484

Provider Business Practice Location Address
First Line	:	120 KINGS WAY
Second Line	:	STE 1500
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-2505
Country	:	US
Telephone Number	:	757-645-3216
Fax Number	:	757-645-3132

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. GEORGE TILTON HEATH
Credential	:	MD
Telephone Number	:	757-645-3216

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	07/21/2022

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