Provider Demographics
NPI:1598797714
Name:SURGERY CENTER OF LYNCHBURG LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF LYNCHBURG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPRISE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:434-947-7700
Mailing Address - Street 1:2401 ATHERHOLT RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501
Mailing Address - Country:US
Mailing Address - Phone:434-947-7700
Mailing Address - Fax:434-947-7711
Practice Address - Street 1:2401 ATHERHOLT RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501
Practice Address - Country:US
Practice Address - Phone:434-947-7700
Practice Address - Fax:434-947-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAOH673261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007603657Medicaid
VA442184OtherANTHEM
VA490000012Medicare UPIN