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
590 W RIDGE RD STE K, WYTHEVILLE, VA 24382-1067
(540) 442-7133
(540) 552-7143
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
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
0102204066
VA
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
06/05/2017
Last updated
06/10/2024
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