Provider Demographics
NPI:1386934586
Name:BUSCH GARDENS WILLIAMSBURG
Entity type:Organization
Organization Name:BUSCH GARDENS WILLIAMSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICES MANGER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-253-3554
Mailing Address - Street 1:1 BUSCH GARDENS BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5664
Mailing Address - Country:US
Mailing Address - Phone:757-253-3554
Mailing Address - Fax:757-253-3032
Practice Address - Street 1:1 BUSCH GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5664
Practice Address - Country:US
Practice Address - Phone:757-253-3554
Practice Address - Fax:757-253-3032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-10
Last Update Date:2011-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle