Provider Demographics
NPI:1841834819
Name:ORTHOVIRGINIA CARE MANAGEMENT LLC
Entity type:Organization
Organization Name:ORTHOVIRGINIA CARE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-915-4600
Mailing Address - Street 1:1115 BOULDERS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-915-4607
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:7858 SHRADER RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4222
Practice Address - Country:US
Practice Address - Phone:804-560-5595
Practice Address - Fax:804-560-9029
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOVIRGINIA CARE MANAGEMENT LLC ORTHOVIRGINIA INC SOLE MBR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty