Healthcare Provider Details

I. General information

NPI: 1073674966
Provider Name (Legal Business Name): VIRGINIA HIGHLANDS ORTHOPAEDIC SPINE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 DAVIS STREET
INDEPENDENCE VA
24348
US

IV. Provider business mailing address

304 DAVIS STREET P.O. BOX 797
INDEPENDENCE VA
24348
US

V. Phone/Fax

Practice location:
  • Phone: 276-773-8145
  • Fax: 276-773-3912
Mailing address:
  • Phone: 276-773-8145
  • Fax: 276-773-3912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LOIS STEWART-WIEBE
Title or Position: OFFICE COORDINATOR
Credential:
Phone: 540-633-0523