Provider Demographics
NPI:1700190170
Name:ORTHOPAEDIC SURGERY AND SPORTS MEDICINE SPECIALISTS
Entity Type:Organization
Organization Name:ORTHOPAEDIC SURGERY AND SPORTS MEDICINE SPECIALISTS
Other - Org Name:ORTHOPAEDIC AND SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-596-1900
Mailing Address - Street 1:250 NAT TURNER BLVD S
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2899
Mailing Address - Country:US
Mailing Address - Phone:757-596-1900
Mailing Address - Fax:866-420-0168
Practice Address - Street 1:250 NAT TURNER BLVD S
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2899
Practice Address - Country:US
Practice Address - Phone:757-596-1900
Practice Address - Fax:866-420-0168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)