Provider Demographics
NPI:1821545294
Name:UNIVERSITY OF VIRGINIA PHYSICIANS GROUP
Entity Type:Organization
Organization Name:UNIVERSITY OF VIRGINIA PHYSICIANS GROUP
Other - Org Name:PROSTHESTICS AND ORTHOTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-980-6117
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:434-295-1000
Mailing Address - Fax:434-972-4266
Practice Address - Street 1:1015 SPRING CREEK PKWY
Practice Address - Street 2:ROOM 2019
Practice Address - City:ZION CROSSROADS
Practice Address - State:VA
Practice Address - Zip Code:22942-7019
Practice Address - Country:US
Practice Address - Phone:434-243-4670
Practice Address - Fax:434-243-4665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-02
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1578685475Medicaid
VA0617000001Medicare NSC