| Orthovirginia, Inc | |
|
2423 Main St Ste 3 Evanston IL 60202-1547 | |
| (571) 470-7544 | |
| Not Available |
| Full Name | Orthovirginia, Inc |
|---|---|
| Speciality | Pharmacy - Mail Order Pharmacy |
| Location | 2423 Main St Ste 3, Evanston, Illinois |
| Authorized Official Name and Position | Nicole Proffitt (CREDENTIALING AND ENROLLMENT) |
| Authorized Official Contact | 8045332357 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Orthovirginia, Inc 2423 Main St Ste 3 Evanston IL 60202-1547 Ph: (571) 470-7544 | Orthovirginia, Inc 2423 Main St Ste 3 Evanston IL 60202-1547 Ph: (571) 470-7544 |
| NPI Number | 1043055239 |
|---|---|
| Provider Enumeration Date | 06/28/2024 |
| Last Update Date | 06/28/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043055239 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 3336M0002X | Pharmacy - Mail Order Pharmacy | (* (Not Available)) | Primary |
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