Provider Demographics
NPI:1093802415
Name:SPECIALIZED ORTHOPAEDIC SERVICES
Entity Type:Organization
Organization Name:SPECIALIZED ORTHOPAEDIC SERVICES
Other - Org Name:SPECIALIZED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BRANCH MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:III
Authorized Official - Credentials:COF
Authorized Official - Phone:757-557-0050
Mailing Address - Street 1:4501 N WITCHDUCK RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6217
Mailing Address - Country:US
Mailing Address - Phone:757-557-0050
Mailing Address - Fax:757-557-0051
Practice Address - Street 1:4501 N WITCHDUCK RD
Practice Address - Street 2:SUITE C
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6217
Practice Address - Country:US
Practice Address - Phone:757-557-0050
Practice Address - Fax:757-557-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0787760002Medicare NSC