Provider Demographics
NPI:1518029131
Name:ION HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:ION HEALTHCARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:804-794-9290
Mailing Address - Street 1:9011 ARBORETUM PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3476
Mailing Address - Country:US
Mailing Address - Phone:804-794-9290
Mailing Address - Fax:804-794-1362
Practice Address - Street 1:603 PILOT HOUSE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1904
Practice Address - Country:US
Practice Address - Phone:757-599-0788
Practice Address - Fax:757-599-3324
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ION HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-14
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1518029131Medicaid
VA305632OtherANTHEM
VA1518029131Medicaid