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General NPI Number Information
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NPI Number | 1831751148
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Entity Type | Organization
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Legal Business Name | ORTHOVIRGINIA, INC.
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 06/03/2022
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Provider Practice Location Address
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Address Line | 125 AKERS FARM RD STE C&D
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City | CHRISTIANSBURG
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State | VA
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Zip | 24073-4866
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Country | US
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Telephone | 540-552-7133
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 715868
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City | PHILADELPHIA
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State | PA
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Zip | 19171-5868
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Country | US
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Telephone | 804-915-1910
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Fax | 804-560-9029
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Authorized Official
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Title or Position | CREDENTIALING & ENROLLMENT
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Name | NICOLE PROFFITT
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Credential |
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Telephone | 804-533-2357
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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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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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