=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932357530
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORTHOCARERN OF FREDERICKSBURG
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2008
-----------------------------------------------------
Last Update Date | 09/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 910 CHARLES ST
-----------------------------------------------------
City | FREDERICKSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22401-5810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-481-1919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 441 CARLISLE DR STE B #100
-----------------------------------------------------
City | HERNDON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20170-4837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-481-1919
-----------------------------------------------------
Fax | 703-481-1944
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | MR. ERIC R CROTSER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-481-1919
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HCO-07362
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------