Provider Demographics
NPI:1841815412
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:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:COLOGGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-596-1900
Mailing Address - Street 1:250 NAT TURNER BLVD S
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3074
Mailing Address - Country:US
Mailing Address - Phone:757-596-1900
Mailing Address - Fax:866-420-0168
Practice Address - Street 1:580 CITY CENTER BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606
Practice Address - Country:US
Practice Address - Phone:757-782-4886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPAEDIC SURGERY & SPORTS MED SPECIALIST OF HAMPTON RDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical