Provider Demographics
NPI:1376560441
Name:PITMAN SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:PITMAN SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-229-4958
Mailing Address - Street 1:326 MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2834
Mailing Address - Country:US
Mailing Address - Phone:757-229-4958
Mailing Address - Fax:757-229-3118
Practice Address - Street 1:326 MONTICELLO AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2834
Practice Address - Country:US
Practice Address - Phone:757-229-4958
Practice Address - Fax:757-229-3118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101014066174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7400870Medicaid
VA283309OtherANTHEM BSBC
C05856Medicare PIN
VAB09187Medicare UPIN