1154176469 NPI number — PRECISION ORTHOPEDICS AND SPORTS MEDICINE

Table of content: (NPI 1154176469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154176469 NPI number — PRECISION ORTHOPEDICS AND SPORTS MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRECISION ORTHOPEDICS AND SPORTS MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154176469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22604-2450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-545-1055
Provider Business Mailing Address Fax Number:
540-678-9025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14904 RICHMOND HWY STE 207
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBRIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22191-3908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-498-0383
Provider Business Practice Location Address Fax Number:
240-382-2962
Provider Enumeration Date:
04/19/2024

Additional Information

Authorized Official

Authorized Official Last Name:
BHATNAGAR
Authorized Official First Name:
RISHI
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
301-498-0383

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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