Basic Information
| Provider Information | |||||||||
| NPI: | 1396156410 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTON COMMUNITY PHYSICIANS SERVICES LLC | ||||||||
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| OtherOrganizationName: | COMMUNITY PHYSICIANS ORTHOPEDICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 509 MEDTECH PKWY | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239522122 | ||||||||
| FaxNumber: | 4239522145 | ||||||||
| Practice Location | |||||||||
| Address1: | 96 15TH ST NW | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | NORTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242731620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2764391463 | ||||||||
| FaxNumber: | 2764391464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2014 | ||||||||
| LastUpdateDate: | 07/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | MULLINS | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED SIGNATOR | ||||||||
| AuthorizedOfficialTelephone: | 2763653060 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1396156410 | 05 | VA | MEDICAID |