ORTHOPAEDIC SURGERY & SPORTS MED SPECIALIST OF HAMPTON RDS PC

Provider Demographics

• NPI: 1801957378
• Name: ORTHOPAEDIC SURGERY & SPORTS MED SPECIALIST OF HAMPTON RDS PC
• Entity type: Organization
• Organization Name: ORTHOPAEDIC SURGERY & SPORTS MED SPECIALIST OF HAMPTON RDS PC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: MANAGING PARTNER
• Authorized Official - First Name: JEFFREY
• Authorized Official - Middle Name: R
• Authorized Official - Last Name: CARLSON
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 757-596-1900
• Mailing Address - Street 1: 250 NAT TURNER BLVD
• Mailing Address - City: NEWPORT NEWS
• Mailing Address - State: VA
• Mailing Address - Zip Code: 23606
• Mailing Address - Country: US
• Mailing Address - Phone: 757-596-1900
• Mailing Address - Fax: 866-420-0168
• Practice Address - Street 1: 250 NAT TURNER BLVD
• Practice Address - City: NEWPORT NEWS
• Practice Address - State: VA
• Practice Address - Zip Code: 23606
• Practice Address - Country: US
• Practice Address - Phone: 757-596-1900
• Practice Address - Fax: 757-591-8560
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-12-12
• Last Update Date: 2020-06-10

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207X00000X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
VA	006451781	Medicaid
VA	006409431	Medicaid
VA	8947465	Medicaid
VA	006401538	Medicaid
VA	010033594	Medicaid
VA	006407188	Medicaid
VA	010179912	Medicaid
	018300O46	Medicare PIN
VA	I51127	Medicare UPIN
	200018017	Medicare PIN
VA	008403P95	Medicare PIN
	G64569	Medicare UPIN
VA	010033594	Medicaid
VA	006401538	Medicaid
	970028725	Medicare PIN
	008289O46	Medicare PIN
VA	I39953	Medicare UPIN
	H80615	Medicare UPIN
	200012852	Medicare PIN
	200000682	Medicare PIN
	200000499	Medicare PIN
VA	010006S88	Medicare PIN
VA	003806O46	Medicare PIN
VA	010179912	Medicaid
	CI5306	Medicare PIN
	P00255762	Medicare PIN
	0000287O46	Medicare PIN
	C32961	Medicare UPIN
VA	8947465	Medicaid
VA	006407188	Medicaid
VA	C02746	Medicare PIN
	200035311	Medicare PIN
	200001014	Medicare PIN