Provider Demographics
NPI:1720695059
Name:CENTRAL VIRGINIA ORTHOPAEDICS & SPORTS MEDICINE, PC
Entity Type:Organization
Organization Name:CENTRAL VIRGINIA ORTHOPAEDICS & SPORTS MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-372-6737
Mailing Address - Street 1:501 PARK HILL DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3377
Mailing Address - Country:US
Mailing Address - Phone:540-656-2786
Mailing Address - Fax:
Practice Address - Street 1:450 GARRISONVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1615
Practice Address - Country:US
Practice Address - Phone:540-659-4555
Practice Address - Fax:540-659-7447
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA ORTHOPAEDICS & SPORTS MEDICINE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-30
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty