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General NPI Number Information
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NPI Number | 1659474807
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Entity Type | Organization
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Legal Business Name | BLACKSBURG ORTHOPAEDICS, PC
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3708 S MAIN ST SUITE G
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City | BLACKSBURG
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State | VA
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Zip | 24060-7007
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Country | US
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Telephone | 540-951-6000
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Fax | 540-951-9400
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Provider Business Mailing Address
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Address Line | 3708 S MAIN ST SUITE G
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City | BLACKSBURG
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State | VA
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Zip | 24060-7007
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Country | US
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Telephone | 540-951-6000
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Fax | 540-951-9400
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEREMY PAUL HATCH
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Credential | M.D.
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Telephone | 540-951-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 0101055538
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License Number State | VA
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