Provider Demographics
NPI:1235115239
Name:SURGERY CENTER OF CHESAPEAKE LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF CHESAPEAKE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CAMARDELLA
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, CHCRM
Authorized Official - Phone:757-312-6250
Mailing Address - Street 1:844 BATTLEFIELD BLVD N
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4802
Mailing Address - Country:US
Mailing Address - Phone:757-312-6800
Mailing Address - Fax:757-312-6361
Practice Address - Street 1:844 BATTLEFIELD BLVD N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4802
Practice Address - Country:US
Practice Address - Phone:757-312-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0220000405261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007603771Medicaid
VA442005OtherANTHEM BLUE CROSS BLUE SHIELD
VA007603771Medicaid