Healthcare Provider Details

I. General information

NPI: 1093309601
Provider Name (Legal Business Name): PRECISION ORTHOPEDICS AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

493 BLACKWELL RD STE 316
WARRENTON VA
20186-2628
US

IV. Provider business mailing address

493 BLACKWELL RD STE 316
WARRENTON VA
20186-2628
US

V. Phone/Fax

Practice location:
  • Phone: 540-905-7775
  • Fax:
Mailing address:
  • Phone: 540-905-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DONNA LEA BOATMAN
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 13-298-5334