Provider Demographics
NPI:1881210805
Name:VIRGINIA GASTROENTEROLOGY INSTITUTE PC
Entity Type:Organization
Organization Name:VIRGINIA GASTROENTEROLOGY INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-942-2566
Mailing Address - Street 1:3910 BRIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-1107
Mailing Address - Country:US
Mailing Address - Phone:757-942-2566
Mailing Address - Fax:855-313-1070
Practice Address - Street 1:3910 BRIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-1107
Practice Address - Country:US
Practice Address - Phone:757-942-2566
Practice Address - Fax:855-313-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health