MEDICARE: HAMPTON ROADS ORTHOPAEDIC & SPORTS MEDICINE LLC

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
1	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1154724813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAMPTON ROADS ORTHOPAEDIC & SPORTS MEDICINE LLC

Provider Business Mailing Address
First Line	:	730 THIMBLE SHOALS BLVD STE 130
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-4562
Country	:	US
Telephone Number	:	757-873-1554
Fax Number	:	757-873-3239

Provider Business Practice Location Address
First Line	:	4030 GEORGE WASHINGTON MEM HWY STE B
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23692-2619
Country	:	US
Telephone Number	:	757-898-5500
Fax Number	:	757-898-5500

Authorized Official
Title or Position	:	CHIEF INFORMATION OFFICER
Name	:	WENDY JACKSON
Credential	:
Telephone Number	:	757-327-0103

Provider Enumeration Date	:	10/08/2014
Last Update Date	:	02/16/2026

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