1811311343 NPI number — COLONIAL ORTHOPAEDICS INC

Table of content: (NPI 1811311343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811311343 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:
Provider Other Organization Name Type Code:
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:
1811311343
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 CHARLES H DIMMOCK PKWY STE 100
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:
23834-2986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-571-5106
Provider Business Mailing Address Fax Number:
804-530-3015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 CHARLES DIMMOCK PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 301
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
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:
02/04/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BAILEY
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
804-571-5106

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" .
  • Taxonomy code: 208100000X , with the licence number: 0101222130 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X , with the licence number: 0101235833 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: 0101224513 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 0103000995 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 2305005628 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X , with the licence number: 2306601247 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X , 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: 363A00000X , with the licence number: 0110003073 , 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: 1811311343 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".