Provider Demographics
NPI:1710685466
Name:TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-313-4701
Mailing Address - Street 1:11166 FAIRFAX BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5025
Mailing Address - Country:US
Mailing Address - Phone:571-367-9849
Mailing Address - Fax:
Practice Address - Street 1:11166 FAIRFAX BLVD STE 105
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5025
Practice Address - Country:US
Practice Address - Phone:571-367-9849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty