Provider Demographics
NPI:1902899784
Name:PENINSULA ANESTHESIA CONSULTANTS LLC
Entity Type:Organization
Organization Name:PENINSULA ANESTHESIA CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:TILTON
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-645-3216
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:TOANO
Mailing Address - State:VA
Mailing Address - Zip Code:23168-0697
Mailing Address - Country:US
Mailing Address - Phone:800-919-1190
Mailing Address - Fax:706-860-6484
Practice Address - Street 1:120 KINGS WAY
Practice Address - Street 2:STE 1500
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2505
Practice Address - Country:US
Practice Address - Phone:757-645-3216
Practice Address - Fax:757-645-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207L00000X, 207LP2900X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09061Medicare PIN