Provider Demographics
NPI:1265677397
Name:LAKEVIEW ANESTHESIA
Entity Type:Organization
Organization Name:LAKEVIEW ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT ANALYST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTELLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-934-9454
Mailing Address - Street 1:2000 MEADE PKWY
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4259
Mailing Address - Country:US
Mailing Address - Phone:757-539-0251
Mailing Address - Fax:757-934-9497
Practice Address - Street 1:2000 MEADE PKWY
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4259
Practice Address - Country:US
Practice Address - Phone:757-539-0251
Practice Address - Fax:757-934-9497
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKEVIEW MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA45025OtherOPTIMA HEALTH CARE