Provider Demographics
NPI:1801831524
Name:SURGICAL ASSOCIATES OF SOUTHWEST VIRGINIA, LLC
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF SOUTHWEST VIRGINIA, LLC
Other - Org Name:SURGICAL ASSOCIATES OF SW VIRGINIA, LLC (MISTAKE)
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-237-7776
Mailing Address - Street 1:2460 LEE HIGHWAY N
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301
Mailing Address - Country:US
Mailing Address - Phone:540-980-9660
Mailing Address - Fax:540-980-9663
Practice Address - Street 1:2460 LEE HIGHWAY N
Practice Address - Street 2:SUITE 4
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301
Practice Address - Country:US
Practice Address - Phone:540-980-9660
Practice Address - Fax:540-980-9663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1801831524Medicaid
VAC09533Medicare ID - Type Unspecified