Organization
ORTHOVIRGINIA, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE PROFFITT (CREDENTIALING AND ENROLLMENT)
(804) 533-2357
Entity
Organization
Contact information
Practice address
2423 MAIN ST STE 3, EVANSTON, IL 60202-1547
(571) 470-7544
Mailing address
2423 MAIN ST STE 3, EVANSTON, IL 60202-1547
(571) 470-7544
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
—
—
3336M0002X
Mail Order Pharmacy
Primary
—
—
Other
Enumeration date
06/28/2024
Last updated
06/28/2024
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