1124230917 NPI number — BLUEFIELD ORTHOPEDICS, P.C.

Table of content: (NPI 1124230917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124230917 NPI number — BLUEFIELD ORTHOPEDICS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUEFIELD ORTHOPEDICS, P.C.
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:
1124230917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1616 WEST CUMBERLAND ROAD
Provider Second Line Business Mailing Address:
P, O, BOX 590
Provider Business Mailing Address City Name:
BLUEFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24605-0590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-322-3461
Provider Business Mailing Address Fax Number:
276-326-6425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1616 W CUMBERLAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUEFIELD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24605-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-322-3461
Provider Business Practice Location Address Fax Number:
276-326-6425
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHAND
Authorized Official First Name:
YOGESH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
276-322-3461

Provider Taxonomy Codes

  • Taxonomy code: 207XP3100X , with the licence number:  0101035143 , 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: C11008 . This is a "MEDICARE PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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