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General NPI Number Information
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NPI Number | 1427544048
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Entity Type | Organization
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Legal Business Name | JSNV MEDICAL LLC
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Dates
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Enumeration Date | 07/06/2018
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 601 OLD WAGNER RD
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City | PETERSBURG
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State | VA
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Zip | 23805-9313
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Country | US
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Telephone | 804-722-3330
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Fax | 888-871-5546
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Provider Business Mailing Address
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Address Line | 864 N MECKLENBURG AVE
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City | SOUTH HILL
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State | VA
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Zip | 23970-4001
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Country | US
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Telephone | 434-755-7896
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH W SIKO JR.
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Credential | DPM
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Telephone | 434-755-7896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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