1083928295 NPI number — VANN VIRGINIA CENTER FOR ORTHOPAEDICS

Table of content: (NPI 1083928295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083928295 NPI number — VANN VIRGINIA CENTER FOR ORTHOPAEDICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VANN VIRGINIA CENTER FOR ORTHOPAEDICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ATLANTIC ORTHOPAEDIC SPECIALISTS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083928295
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 CLEARFIELD AVE
Provider Second Line Business Mailing Address:
SUITE 124
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23462-1832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-321-3300
Provider Business Mailing Address Fax Number:
757-321-3332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
733 VOLVO PKWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23320-1609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-226-9935
Provider Business Practice Location Address Fax Number:
757-436-0781
Provider Enumeration Date:
07/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
CECIL
Authorized Official Middle Name:
FM
Authorized Official Title or Position:
CFO PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
757-321-3300

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C05501 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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