Healthcare Provider Details

I. General information

NPI: 1780932970
Provider Name (Legal Business Name): COLONIAL ORTHOPAEDICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13038 RIVERS BEND RD
CHESTER VA
23836-2564
US

IV. Provider business mailing address

13000 RIVERS BEND BLVD # D
CHESTER VA
23836
US

V. Phone/Fax

Practice location:
  • Phone: 804-526-5888
  • Fax: 804-526-5401
Mailing address:
  • Phone: 804-571-5000
  • Fax: 804-518-1314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number0110001332
License Number StateVA

VIII. Authorized Official

Name: DEE DEE ALVIS
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 804-571-5132