Provider Demographics
NPI:1912147497
Name:THE AESTHETIC CENTER, PC
Entity Type:Organization
Organization Name:THE AESTHETIC CENTER, PC
Other - Org Name:THE AESTHETIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-687-1900
Mailing Address - Street 1:329 PHILLIP AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4380
Mailing Address - Country:US
Mailing Address - Phone:757-687-1900
Mailing Address - Fax:757-687-1895
Practice Address - Street 1:329 PHILLIP AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4380
Practice Address - Country:US
Practice Address - Phone:757-687-1900
Practice Address - Fax:757-687-1895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA440392OtherBCBS
VA440392OtherBCBS
VAGC1061SC0001043Medicare PIN