Healthcare Provider Details

I. General information

NPI: 1649317660
Provider Name (Legal Business Name): ORTHOVIRGINIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7858 SHRADER ROAD
RICHMOND VA
23294-4222
US

IV. Provider business mailing address

PO BOX 715868
PHILADELPHIA PA
19171-5868
US

V. Phone/Fax

Practice location:
  • Phone: 804-270-1305
  • Fax: 804-273-9294
Mailing address:
  • Phone: 804-915-1910
  • Fax: 804-560-9029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE PROFFITT
Title or Position: CREDENTIALING/ENROLLMENT
Credential:
Phone: 804-533-2357