Provider Demographics
NPI:1528027026
Name:VIRGINIA BEACH AMBULATORY SURGERY CENTER
Entity Type:Organization
Organization Name:VIRGINIA BEACH AMBULATORY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-496-6400
Mailing Address - Street 1:1700 WILL O WISP DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3164
Mailing Address - Country:US
Mailing Address - Phone:757-496-6400
Mailing Address - Fax:757-496-3137
Practice Address - Street 1:1700 WILL O WISP DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3164
Practice Address - Country:US
Practice Address - Phone:757-496-6400
Practice Address - Fax:757-496-3137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAOH681261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007671008Medicaid
VA490491012Medicare ID - Type Unspecified