Provider Demographics
NPI:1447489695
Name:AMBULATORY SURGERY CENTER AT VIRTUA WASHINGTON TOWNSHIP, L.L.C.
Entity type:Organization
Organization Name:AMBULATORY SURGERY CENTER AT VIRTUA WASHINGTON TOWNSHIP, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:STINCHCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CASC
Authorized Official - Phone:479-267-2756
Mailing Address - Street 1:11641 CHARLES CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-8782
Mailing Address - Country:US
Mailing Address - Phone:479-267-2756
Mailing Address - Fax:479-267-2757
Practice Address - Street 1:239 HURFFVILLE CROSSKEYS RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4001
Practice Address - Country:US
Practice Address - Phone:479-267-2756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical