Organization
SOUTHWEST VIRGINIA ORTHOPEDIC AND SPINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM TEDRICK JOHNSON (VP)
(804) 237-7760
Entity
Organization
Contact information
Practice address
809 DAVIS ST, SUITE 2, BLACKSBURG, VA 24060-7013
(540) 951-6000
(540) 951-9400
Mailing address
809 DAVIS ST, SUITE 2, BLACKSBURG, VA 24060-7013
(540) 951-6000
(540) 951-9400
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255431250
—
VA
01
—
DG1185
RR MEDICARE
VA
Enumeration date
09/22/2006
Last updated
12/21/2010
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