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NPI Code Detail

MEDICARE: JORDAN-YOUNG INSTITUTE FOR RECONSTRUCTIVE SURGERY AND SPORTS

MEDICARE: JORDAN-YOUNG INSTITUTE FOR RECONSTRUCTIVE SURGERY AND SPORTS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XS0114XAdult Reconstructive Orthopaedic Surgery Physician
2207XX0004XOrthopaedic Foot and Ankle Surgery Physician
3207XX0005XSports Medicine (Orthopaedic Surgery) Physician
4207X00000XOrthopaedic Surgery Physician

General Provider Information

NPI Number : 1033145404
Entity Type Code : Organization
Provider Name (Legal Business Name) : JORDAN-YOUNG INSTITUTE FOR RECONSTRUCTIVE SURGERY AND SPORTS
Provider Business Mailing Address
First Line : 5716 CLEVELAND ST
Second Line : SUITE 200
City : VIRGINIA BEACH
State : VA
Zip : 23462-1784
Country : US
Telephone Number : 757-502-8570
Fax Number : 757-961-9767
Provider Business Practice Location Address
First Line : 5716 CLEVELAND ST
Second Line : SUITE 200
City : VIRGINIA BEACH
State : VA
Zip : 23462-1784
Country : US
Telephone Number : 757-502-8570
Fax Number : 757-961-9767
Authorized Official
Title or Position : DIRECTOR REVENUE CYCLE
Name : DEBRA RUNGE-ASHBY
Credential :
Telephone Number : 757-490-4943
Provider Enumeration Date : 06/25/2006
Last Update Date : 07/05/2022

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Directions to “JORDAN-YOUNG INSTITUTE FOR RECONSTRUCTIVE SURGERY AND SPORTS ” Practice Location

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