Provider Demographics
NPI:1669526711
Name:HAMPTON ROADS ORTHOPAEDIC & SPORTS MEDICINE LLC
Entity type:Organization
Organization Name:HAMPTON ROADS ORTHOPAEDIC & SPORTS MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF INFORMATION OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-873-1554
Mailing Address - Street 1:730 THIMBLE SHOALS BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4562
Mailing Address - Country:US
Mailing Address - Phone:757-926-4351
Mailing Address - Fax:757-534-9100
Practice Address - Street 1:730 THIMBLE SHOALS BLVD STE 120
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4562
Practice Address - Country:US
Practice Address - Phone:757-873-1554
Practice Address - Fax:757-873-3239
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAMPTON ROADS ORTHOPAEDIC & SPORTS MEDICINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-23
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAFVX015Medicare PIN