Healthcare Provider Details

I. General information

NPI: 1700190170
Provider Name (Legal Business Name): ORTHOPAEDIC SURGERY AND SPORTS MEDICINE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 NAT TURNER BLVD S
NEWPORT NEWS VA
23606-2899
US

IV. Provider business mailing address

250 NAT TURNER BLVD S
NEWPORT NEWS VA
23606-2899
US

V. Phone/Fax

Practice location:
  • Phone: 757-596-1900
  • Fax: 866-420-0168
Mailing address:
  • Phone: 757-596-1900
  • Fax: 866-420-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY R CARLSON
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 757-596-1900