Provider Demographics
NPI:1154323988
Name:CENTRAL VIRGINIA SURGI-CENTER LP
Entity Type:Organization
Organization Name:CENTRAL VIRGINIA SURGI-CENTER LP
Other - Org Name:SURGI-CENTER OF CENTRAL VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:540-371-5349
Mailing Address - Street 1:1500 DIXON ST
Mailing Address - Street 2:STE 101, MAILBOX 1
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-7231
Mailing Address - Country:US
Mailing Address - Phone:540-371-5349
Mailing Address - Fax:540-373-1745
Practice Address - Street 1:1500 DIXON ST
Practice Address - Street 2:STE 101, MAILBOX 1
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-7231
Practice Address - Country:US
Practice Address - Phone:540-371-5349
Practice Address - Fax:540-373-1745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2014-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAOH 674261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007604050Medicaid
VA437844OtherMAMSI
VA62413OtherFIRST HEALTH
VA1039920OtherAETNA HMO
VA34196OtherAPPEX BENEFIT SERVICE
VA437844OtherOPTIMUM CHOICE
VA8561085OtherAETNA PPO
VA87726AOtherUNITED HEALTH CARE
VA437844OtherMDIPA
VA437844OtherALLIANCE PPO
VA95226OtherHARRINGTON BENEFIT SERV
VA442252OtherANTHEM
VA490005350Medicaid
VA62413OtherMAIL HANDLERS
VAP00148932OtherRAILROAD MEDICARE
VA1039920OtherAETNA HMO
VA95226OtherHARRINGTON BENEFIT SERV