Basic Information
| Provider Information | |||||||||
| NPI: | 1831273192 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHOPAEDIC SURGERY CENTERS, PC II | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 HIGH ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237073321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573970783 | ||||||||
| FaxNumber: | 7573970236 | ||||||||
| Practice Location | |||||||||
| Address1: | 3300 HIGH ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237073321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573970783 | ||||||||
| FaxNumber: | 7573970236 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 08/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | DONAFRIO | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| 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 | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 191956 | 01 | VA | BCBS OT PROVIDER NUMBER | OTHER | 191957 | 01 | VA | BCBS PT PROVIDER NUMBER | OTHER | 150434301 | 01 | VA | DEPT OF LABOR | OTHER |