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General NPI Number Information
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NPI Number | 1093309601
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Entity Type | Organization
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Legal Business Name | PRECISION ORTHOPEDICS AND SPORTS MEDICINE
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Dates
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Enumeration Date | 02/24/2021
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 493 BLACKWELL RD STE 316
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City | WARRENTON
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State | VA
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Zip | 20186-2628
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Country | US
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Telephone | 540-905-7775
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Fax |
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Provider Business Mailing Address
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Address Line | 493 BLACKWELL RD STE 316
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City | WARRENTON
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State | VA
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Zip | 20186-2628
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Country | US
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Telephone | 540-905-7775
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | DONNA LEA BOATMAN
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Credential |
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Telephone | 13-298-5334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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