=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124230917
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUEFIELD ORTHOPEDICS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2007
-----------------------------------------------------
Last Update Date | 07/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1616 W CUMBERLAND RD
-----------------------------------------------------
City | BLUEFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24605-2005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-322-3461
-----------------------------------------------------
Fax | 276-326-6425
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1616 WEST CUMBERLAND ROAD P, O, BOX 590
-----------------------------------------------------
City | BLUEFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24605-0590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-322-3461
-----------------------------------------------------
Fax | 276-326-6425
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. YOGESH CHAND
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 276-322-3461
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XP3100X
-----------------------------------------------------
Taxonomy Name | Pediatric Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 0101035143
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------