Organization
ORTHOVIRGINIA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE PROFFITT (CREDENTIALING & ENROLLMENT)
(804) 533-2357
Entity
Organization
Contact information
Practice address
1409 S MAIN STREET, FARMVILLE, VA 23901-2531
(434) 207-5170
(434) 485-8599
Mailing address
PO BOX 715868, PHILADELPHIA, PA 19171-5868
(804) 915-1910
(804) 560-9029
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
—
VA
363L00000X
Nurse Practitioner
—
VA
Other
Enumeration date
10/22/2007
Last updated
03/31/2023
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