Provider Demographics
NPI:1952749491
Name:HAYMARKET SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:HAYMARKET SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-376-7315
Mailing Address - Street 1:15195 HEATHCOTE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-6245
Mailing Address - Country:US
Mailing Address - Phone:571-445-3800
Mailing Address - Fax:571-261-9812
Practice Address - Street 1:15195 HEATHCOTE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-6242
Practice Address - Country:US
Practice Address - Phone:571-445-3800
Practice Address - Fax:571-261-9812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
49C0001062OtherMEDICARE CCN
49C0001062OtherMEDICARE CCN