| Orthovirginia, Inc. | |
|
12216 W Broad Street Suite 4b-5 Henrico VA 23233-1602 | |
| (804) 440-4878 | |
| (804) 200-7124 |
| Full Name | Orthovirginia, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 12216 W Broad Street, Henrico, Virginia |
| Authorized Official Name and Position | Nicole Proffitt (CREDENTIALING AND ENROLLMENT) |
| Authorized Official Contact | 8045332357 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Orthovirginia, Inc. Po Box 715868 Philadelphia PA 19171-5868 Ph: (804) 915-1910 | Orthovirginia, Inc. 12216 W Broad Street Suite 4b-5 Henrico VA 23233-1602 Ph: (804) 440-4878 |
| NPI Number | 1104542612 |
|---|---|
| Provider Enumeration Date | 10/17/2022 |
| Last Update Date | 10/17/2022 |
| Medicare PECOS PAC ID | 0547157224 |
|---|---|
| Medicare Enrollment ID | O20230613003613 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104542612 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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