1770613895 NPI number — VANN-VIRGINIA CENTER FOR ORTHOPAEDICS PC

Table of content: (NPI 1770613895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770613895 NPI number — VANN-VIRGINIA CENTER FOR ORTHOPAEDICS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VANN-VIRGINIA CENTER FOR ORTHOPAEDICS PC
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:
1770613895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2018
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:
757-321-3383
Provider Business Mailing Address Fax Number:
757-321-3332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 KINGSLEY LN
Provider Second Line Business Practice Location Address:
SUITE 405
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-321-3300
Provider Business Practice Location Address Fax Number:
757-321-3332
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOGGE
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MANGER
Authorized Official Telephone Number:
757-321-3398

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  0101041556 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: CE8289 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1230520003 . This is a "DMERC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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