Basic Information
Provider Information | |||||||||
NPI: | 1396945291 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | COLONIAL ORTHOPAEDICS | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | COLONIAL ORTHOPAEDICS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 13000 RIVERS BEND BLVD STE D | ||||||||
Address2: |   | ||||||||
City: | CHESTER | ||||||||
State: | VA | ||||||||
PostalCode: | 238368632 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8045715000 | ||||||||
FaxNumber: | 8045181314 | ||||||||
Practice Location | |||||||||
Address1: | 13048 RIVERS BEND ROAD | ||||||||
Address2: |   | ||||||||
City: | CHESTER | ||||||||
State: | VA | ||||||||
PostalCode: | 238362564 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8045303330 | ||||||||
FaxNumber: | 8045309998 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/19/2007 | ||||||||
LastUpdateDate: | 02/19/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ALVIS | ||||||||
AuthorizedOfficialFirstName: | DEE DEE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | OPERATIONS MANAGER | ||||||||
AuthorizedOfficialTelephone: | 8045715132 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X |   |   | N |   | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 332B00000X |   |   | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
No ID Information.