Provider Demographics
NPI:1821148859
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:540-633-0523
Mailing Address - Street 1:PO BOX 797
Mailing Address - Street 2:304 DAVIS ST
Mailing Address - City:INDEPENDENCE
Mailing Address - State:VA
Mailing Address - Zip Code:24348-0797
Mailing Address - Country:US
Mailing Address - Phone:276-773-8145
Mailing Address - Fax:
Practice Address - Street 1:51 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1577
Practice Address - Country:US
Practice Address - Phone:540-633-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012254392251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C08776Medicare ID - Type UnspecifiedGROUP NUMBER