Provider Demographics
NPI:1033145404
Name:JORDAN-YOUNG INSTITUTE FOR RECONSTRUCTIVE SURGERY AND SPORTS
Entity Type:Organization
Organization Name:JORDAN-YOUNG INSTITUTE FOR RECONSTRUCTIVE SURGERY AND SPORTS
Other - Org Name:JORDAN-YOUNG INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNGE-ASHBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-490-4943
Mailing Address - Street 1:5716 CLEVELAND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1784
Mailing Address - Country:US
Mailing Address - Phone:757-502-8570
Mailing Address - Fax:757-961-9767
Practice Address - Street 1:5716 CLEVELAND ST
Practice Address - Street 2:SUITE 200
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1784
Practice Address - Country:US
Practice Address - Phone:757-502-8570
Practice Address - Fax:757-961-9767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5877300001Medicare NSC