Basic Information
| Provider Information | |||||||||
| NPI: | 1427147826 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHOPAEDIC SURGERY CENTERS, PC II | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7848 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237070848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573980779 | ||||||||
| FaxNumber: | 7573980030 | ||||||||
| Practice Location | |||||||||
| Address1: | 5838 HARBOUR VIEW BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234352663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574830407 | ||||||||
| FaxNumber: | 7574833075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 09/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | COLOGGI | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7573979015 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 150434302 | 01 | VA | DEPT OF LABOR | OTHER | 191958 | 01 | VA | BCBS PT PROVIDER NUMBER | OTHER | 191959 | 01 | VA | BCBS OT PROVIDER NUMBER | OTHER |