Healthcare Provider Details

I. General information

NPI: 1093802415
Provider Name (Legal Business Name): SPECIALIZED ORTHOPAEDIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 N WITCHDUCK RD SUITE C
VIRGINIA BEACH VA
23455-6217
US

IV. Provider business mailing address

4501 N WITCHDUCK RD SUITE C
VIRGINIA BEACH VA
23455-6217
US

V. Phone/Fax

Practice location:
  • Phone: 757-557-0050
  • Fax: 757-557-0051
Mailing address:
  • Phone: 757-557-0050
  • Fax: 757-557-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES S DAVIS III
Title or Position: BRANCH MANAGER
Credential: C.O.F.
Phone: 757-557-0050