Provider Demographics
NPI:1851505176
Name:COLONIAL ORTHOPAEDICS INC
Entity Type:Organization
Organization Name:COLONIAL ORTHOPAEDICS INC
Other - Org Name:COLONIAL ORTHOPAEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEE DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-571-5132
Mailing Address - Street 1:13000 RIVERS BEND BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-8632
Mailing Address - Country:US
Mailing Address - Phone:804-571-5000
Mailing Address - Fax:804-518-1314
Practice Address - Street 1:131 JENNICK DR
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-4905
Practice Address - Country:US
Practice Address - Phone:804-526-5888
Practice Address - Fax:804-526-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACO1167Medicare PIN