Provider Demographics
NPI:1104835933
Name:VIRGINIA HIGHLANDS ORTHOPAEDIC SPINE CENTER LLC
Entity Type:Organization
Organization Name:VIRGINIA HIGHLANDS ORTHOPAEDIC SPINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GRUBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-773-8145
Mailing Address - Street 1:2900 LAMB CIRCLE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073
Mailing Address - Country:US
Mailing Address - Phone:540-633-0523
Mailing Address - Fax:540-633-0526
Practice Address - Street 1:2900 LAMB CIRCLE
Practice Address - Street 2:SUITE 380
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073
Practice Address - Country:US
Practice Address - Phone:540-633-0523
Practice Address - Fax:540-633-0526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101225439261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB4862OtherRAILROAD MEDICARE
CB4862OtherRAILROAD MEDICARE
=========OtherTAX ID