Provider Demographics
NPI:1750604443
Name:VANN-VIRGINIA CENTER FOR ORTHOPAEDICS PC
Entity type:Organization
Organization Name:VANN-VIRGINIA CENTER FOR ORTHOPAEDICS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:JACOT
Authorized Official - Last Name:GESICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-321-3383
Mailing Address - Street 1:230 CLEARFIELD AVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1832
Mailing Address - Country:US
Mailing Address - Phone:757-321-3383
Mailing Address - Fax:757-321-3332
Practice Address - Street 1:1309 EXECUTIVE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3671
Practice Address - Country:US
Practice Address - Phone:757-321-3300
Practice Address - Fax:757-321-3332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VANN-VIRGINIA CENTER FOR ORTHOPAEDICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-09
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002825225100000X
VA0119003467225XH1200X
VA0101041556207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05501OtherMEDICARE GROUP