Provider Demographics
NPI:1083929491
Name:VANN VIRGINIA CENTER FOR ORTHOPAEDICS
Entity Type:Organization
Organization Name:VANN VIRGINIA CENTER FOR ORTHOPAEDICS
Other - Org Name:ATLANTIC ORTHOPAEDIC SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:FM
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:757-321-3300
Mailing Address - Street 1:230 CLEARFIELD AVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1832
Mailing Address - Country:US
Mailing Address - Phone:757-321-3300
Mailing Address - Fax:757-321-3332
Practice Address - Street 1:1800 CAMELOT DR
Practice Address - Street 2:SUITE 300
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2440
Practice Address - Country:US
Practice Address - Phone:757-321-4284
Practice Address - Fax:757-321-4287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05501OtherMEDICARE GROUP PTAN