Provider Demographics
NPI:1811255359
Name:SURPASSION HEALTHCARE SERVICES INC
Entity type:Organization
Organization Name:SURPASSION HEALTHCARE SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EI SERVICE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CEO, ADMINISTRATOR
Authorized Official - Phone:540-412-5529
Mailing Address - Street 1:5006 STRAUSS CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-7776
Mailing Address - Country:US
Mailing Address - Phone:540-479-2552
Mailing Address - Fax:540-412-5563
Practice Address - Street 1:4820 SOUTHPOINT DR STE 203
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-2614
Practice Address - Country:US
Practice Address - Phone:540-412-5529
Practice Address - Fax:540-412-5563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA252Y00000X
VAHCO-14985251B00000X, 251J00000X, 251F00000X, 332B00000X
3747P1801X, 385H00000X, 163WC2100X, 253Z00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
No163WC2100XNursing Service ProvidersRegistered NurseContinence CareGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1811255359Medicaid
VA0172382647Medicaid