1720015852 NPI number — COLONIAL ORTHOPAEDICS, INC

Table of content: (NPI 1720015852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720015852 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 & VA OSTEOPOROSIS CLINIC
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:
1720015852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 JENNICK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLONIAL HEIGHTS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23834-4905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-526-5888
Provider Business Mailing Address Fax Number:
804-526-5401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOPEWELL
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23860-2719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-541-2979
Provider Business Practice Location Address Fax Number:
804-452-1270
Provider Enumeration Date:
06/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
FINANCIAL MANAGER
Authorized Official Telephone Number:
804-526-5888

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  0101034297 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X , with the licence number: 0101036726 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X , with the licence number: 0101226595 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0114X , with the licence number: 0101231604 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0117X , with the licence number: 0101237849 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0004X , with the licence number: 0101045456 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X , with the licence number: 0101052925 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 006409270 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 285195 . This is a "ANTHEM-PRAKASH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 006409261 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006409288 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010185220 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010174643 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 285196 . This is a "ANTHEM-SARAIYA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 285454335 . This is a "ANTHEM-DHILLON" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 454337 . This is a "ANTHEM-SRIVASTAVA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 006409211 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006409253 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 285194 . This is a "ANTHEM-BHULLER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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