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General NPI Number Information
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NPI Number | 1699243402
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Entity Type | Organization
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Legal Business Name | SPORT MEDICINE AND ORTHOPAEDIC CENTER INC
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Dates
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Enumeration Date | 11/09/2018
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 5801 HARBOUR VIEW BLVD
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City | SUFFOLK
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State | VA
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Zip | 23435-2657
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Country | US
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Telephone | 757-547-5145
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Fax |
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Provider Business Mailing Address
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Address Line | 501 DISCOVERY DR
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3832
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Country | US
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Telephone | 757-547-5145
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF REVENUE CYCLE
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Name | DEBRA RUNGE-ASHBY
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Credential |
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Telephone | 757-547-5145
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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 |
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License Number State |
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