Organization
PHENOM SURGICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS LAMONT HEGENS LCSA (OWNER/CEO)
(703) 659-4557
Entity
Organization
Contact information
Practice address
2750 PROSPERITY AVE, #120, FAIRFAX, VA 22031-4312
(703) 659-4557
(703) 205-9010
Mailing address
8116 ARLINGTON BLVD, #183, FALLS CHURCH, VA 22042-1002
(703) 659-4557
(703) 205-2010
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2906
NATIONAL SURGICAL ASSISTANT ASSOCIATION
VA
01
—
SA0017
DEPARTMENT OF HEALTH, HEALTH PROFESSIONAL LICENSING ADMINISTRATION
DC
Enumeration date
09/05/2012
Last updated
05/16/2016
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