1336270289 NPI number — COLONIAL ORTHOPAEDICS, INC

Table of content: (NPI 1336270289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336270289 NPI number — COLONIAL ORTHOPAEDICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLONIAL ORTHOPAEDICS, INC
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:
COLONIAL ORTHOPAEDICS
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:
1336270289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13000 RIVERS BEND BLVD STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23836-8632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-571-5000
Provider Business Mailing Address Fax Number:
804-518-1314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 JENNICK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLONIAL HEIGHTS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23834-4905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-526-5888
Provider Business Practice Location Address Fax Number:
804-526-5401
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALVIS
Authorized Official First Name:
DEE DEE
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
804-571-5132

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  0119000261 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X , with the licence number: 2305005628 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 182898 . This is a "SOUTHERN HEALTH PT OT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 194507 . This is a "ANTHEM PT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5654515 . This is a "FIRST HEALTH MAILHANDLERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 194508 . This is a "ANTHEM OT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 10002763 . This is a "OPTIMA PT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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