1831580646 NPI number — THE ORTHOPAEDIC INSTITUTE OF VIRGINIA PLLC

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 1831580646 NPI number — THE ORTHOPAEDIC INSTITUTE OF VIRGINIA PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE ORTHOPAEDIC INSTITUTE OF VIRGINIA PLLC
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:
1831580646
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8814 FARGO RD
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23229-4647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-288-2830
Provider Business Mailing Address Fax Number:
804-288-2850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 MAPLE AVE
Provider Second Line Business Practice Location Address:
NW MOB, SUITE 200
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23226-2553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-285-2300
Provider Business Practice Location Address Fax Number:
804-285-8420
Provider Enumeration Date:
02/16/2015

Additional Information

Authorized Official

Authorized Official Last Name:
NICHOLS
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
WILSON
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
804-288-2830

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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