1821545294 NPI number — UNIVERSITY OF VIRGINIA PHYSICIANS GROUP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821545294 NPI number — UNIVERSITY OF VIRGINIA PHYSICIANS GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF VIRGINIA PHYSICIANS GROUP
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:
PROSTHESTICS AND ORTHOTICS
Provider Other Organization Name Type Code:
5
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:
1821545294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9007
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22906-9007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-295-1000
Provider Business Mailing Address Fax Number:
434-972-4266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 SPRING CREEK PKWY
Provider Second Line Business Practice Location Address:
ROOM 2019
Provider Business Practice Location Address City Name:
ZION CROSSROADS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22942-7019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-243-4670
Provider Business Practice Location Address Fax Number:
434-243-4665
Provider Enumeration Date:
09/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HAWS
Authorized Official First Name:
BRAD
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
434-980-6117

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , 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: 1578685475 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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