Provider Demographics
NPI:1619445426
Name:SPORT MEDICINE AND ORTHOPAEDIC CENTER INC
Entity Type:Organization
Organization Name:SPORT MEDICINE AND ORTHOPAEDIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CULP
Authorized Official - Suffix:
Authorized Official - Credentials:SHRM-CP
Authorized Official - Phone:757-842-7010
Mailing Address - Street 1:814 GREENBRIER CIR STE F
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2643
Mailing Address - Country:US
Mailing Address - Phone:577-842-7010
Mailing Address - Fax:
Practice Address - Street 1:150 BURNETTS WAY STE 100
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8168
Practice Address - Country:US
Practice Address - Phone:757-547-5145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty