Provider Demographics
NPI:1891088449
Name:VIRGINIA SURGICAL CARE CENTER PC
Entity Type:Organization
Organization Name:VIRGINIA SURGICAL CARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MURALIDHARAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BASKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-931-7720
Mailing Address - Street 1:PO BOX 11768
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-0168
Mailing Address - Country:US
Mailing Address - Phone:804-353-4000
Mailing Address - Fax:804-213-9783
Practice Address - Street 1:16021 KAIROS RD
Practice Address - Street 2:SUITE A
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-5205
Practice Address - Country:US
Practice Address - Phone:804-931-7720
Practice Address - Fax:804-451-1852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242063208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1972543650OtherPROVIDER NPI
VA1972543650OtherPROVIDER NPI
VAVV17899909Medicare PIN