Provider Demographics
NPI:1386829810
Name:WARREN SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:WARREN SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN MANAGEMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BAMBIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:COMPHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-771-0258
Mailing Address - Street 1:136 LINDEN DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6900
Mailing Address - Country:US
Mailing Address - Phone:540-635-1652
Mailing Address - Fax:
Practice Address - Street 1:1077 N SHENANDOAH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-3546
Practice Address - Country:US
Practice Address - Phone:540-635-1652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10402Medicare PIN