MEDICARE: VANN-VIRGINIA CENTER FOR ORTHOPAEDICS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305003416	VA
2	225XH1200X	Hand Occupational Therapist	0119003467	VA
3	207X00000X	Orthopaedic Surgery Physician	0101041556	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	005641847	OTHER	VA	TRICARE SS#

General Provider Information

NPI Number	:	1184666877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANN-VIRGINIA CENTER FOR ORTHOPAEDICS PC

Provider Business Mailing Address
First Line	:	230 CLEARFIELD AVE
Second Line	:	SUITE 124
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1832
Country	:	US
Telephone Number	:	757-321-3383
Fax Number	:	757-321-3332

Provider Business Practice Location Address
First Line	:	230 CLEARFIELD AVE
Second Line	:	SUITE 124
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1832
Country	:	US
Telephone Number	:	757-321-3383
Fax Number	:	757-321-3332

Authorized Official
Title or Position	:	BUSINESS OFFICE MANGER
Name	:	MRS. DEBRA HOGGE
Credential	:
Telephone Number	:	757-321-3398

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	09/17/2015

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