Provider Demographics
NPI:1659474807
Name:BLACKSBURG ORTHOPAEDICS, PC
Entity Type:Organization
Organization Name:BLACKSBURG ORTHOPAEDICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-951-6000
Mailing Address - Street 1:3708 S MAIN ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7007
Mailing Address - Country:US
Mailing Address - Phone:540-951-6000
Mailing Address - Fax:540-951-9400
Practice Address - Street 1:3708 S MAIN ST
Practice Address - Street 2:SUITE G
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7007
Practice Address - Country:US
Practice Address - Phone:540-951-6000
Practice Address - Fax:540-951-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055538207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA147715OtherSOUTHERN HEALTH
VA141234OtherANTHEM HEALTH PLANS
VA349912OtherALLIANCE
VA1178036OtherFIRST HEALTH
VA5834500OtherAETNA HEALTH PLANS
VA349912OtherMAMSI
VA5834500OtherAETNA HEALTH PLANS
VA349912OtherALLIANCE