Provider Demographics
NPI:1740236454
Name:PRINCESS ANNE AMBULATORY SURGERY MANAGEMENT LLC
Entity Type:Organization
Organization Name:PRINCESS ANNE AMBULATORY SURGERY MANAGEMENT LLC
Other - Org Name:PRINCESS ANNE AMBULATORY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-455-7766
Mailing Address - Street 1:1975 GLENN MITCHELL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0167
Mailing Address - Country:US
Mailing Address - Phone:757-507-0170
Mailing Address - Fax:757-507-0171
Practice Address - Street 1:1975 GLENN MITCHELL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0167
Practice Address - Country:US
Practice Address - Phone:757-507-0170
Practice Address - Fax:757-507-0171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical