Organization
SPORT MEDICINE AND ORTHOPAEDIC CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA RUNGE-ASHBY (DIRECTOR OF REVENUE CYCLE)
(757) 547-5145
Entity
Organization
Contact information
Practice address
501 DISCOVERY DR., CHESAPEAKE, VA 23320
(757) 547-5145
(757) 436-2480
Mailing address
501 DISCOVERY DR, CHESAPEAKE, VA 23320-3832
(757) 547-5145
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XS0106X
Orthopaedic Hand Surgery Physician
—
—
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
—
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
225100000X
Physical Therapist
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CL7629
MEDICARE RAILROAD
VA
Enumeration date
06/25/2006
Last updated
08/16/2024
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