Provider Demographics
NPI:1891876512
Name:MIDATLANTIC SPINE SPECIALISTS P C
Entity Type:Organization
Organization Name:MIDATLANTIC SPINE SPECIALISTS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HALLETT
Authorized Official - Middle Name:H
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-270-5163
Mailing Address - Street 1:7650 E PARHAM RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4373
Mailing Address - Country:US
Mailing Address - Phone:804-270-5163
Mailing Address - Fax:
Practice Address - Street 1:7650 E PARHAM RD
Practice Address - Street 2:SUITE 301
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4373
Practice Address - Country:US
Practice Address - Phone:804-270-5163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC04570Medicare ID - Type UnspecifiedMEDICARE GROUP #
VAC05292Medicare ID - Type UnspecifiedGROUP #-WILLIAMSBURG