Healthcare Provider Details

I. General information

NPI: 1720069271
Provider Name (Legal Business Name): SPINAL SURGERY ASSOCIATES PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PETER JEFFERSON PKWY STE 170
CHARLOTTESVILLE VA
22911-8835
US

IV. Provider business mailing address

600 PETER JEFFERSON PKWY STE 170
CHARLOTTESVILLE VA
22911-8835
US

V. Phone/Fax

Practice location:
  • Phone: 434-977-3001
  • Fax: 434-977-3002
Mailing address:
  • Phone: 434-977-3001
  • Fax: 434-977-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM SUKOVICH
Title or Position: OWNER
Credential: MD
Phone: 434-977-3001