Organization
HANOVER OUTPATIENT SURGERY CENTER, L.P.
Active
Other names
Hanover Outpatient Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
DON LIEDTKE (VICE PRESIDENT)
(615) 344-5507
Entity
Organization
Contact information
Practice address
7016 LEE PARK RD, MECHANICSVILLE, VA 23111-3682
(804) 730-9000
(804) 730-1460
Mailing address
7016 LEE PARK RD, MECHANICSVILLE, VA 23111-3682
(804) 730-9000
(804) 730-1460
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
OH657
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010188334
—
VA
Enumeration date
04/07/2006
Last updated
05/24/2012
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