Provider Demographics
NPI:1265471510
Name:SURGI-CENTER OF WINCHESTER, INC
Entity Type:Organization
Organization Name:SURGI-CENTER OF WINCHESTER, INC
Other - Org Name:SURGI-CENTER OF WINCHESTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:KLIEWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-536-7870
Mailing Address - Street 1:1860 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2808
Mailing Address - Country:US
Mailing Address - Phone:540-536-7870
Mailing Address - Fax:540-667-4197
Practice Address - Street 1:1860 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2808
Practice Address - Country:US
Practice Address - Phone:540-536-7870
Practice Address - Fax:540-667-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAOH 675261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007666501OtherVIRGINIA PREMIER
WV0017527000Medicaid
VA2122068OtherMAMSI,MAPSI,MDIPA
VA2122068OtherALLIANCE,OPTIMUM CHOICE
VA095822OtherANTHEM
VA007666501Medicaid
VA0040029OtherSLH
VA84009OtherSOUTHERN HEALTH
VA0040029OtherSLH
VA2122068OtherALLIANCE,OPTIMUM CHOICE
VA007666501OtherVIRGINIA PREMIER