Organization
SOUTHWEST VIRGINIA ORTHOPEDIC AND SPINE LLC
Active
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
Update your record
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