Provider Demographics
NPI:1104977289
Name:ORTHOPEDIC CLINIC OF CENTRAL VIRGINIA P C
Entity type:Organization
Organization Name:ORTHOPEDIC CLINIC OF CENTRAL VIRGINIA P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BIDDULPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-370-4330
Mailing Address - Street 1:PO BOX 1750
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22555-1750
Mailing Address - Country:US
Mailing Address - Phone:540-370-1600
Mailing Address - Fax:540-370-1699
Practice Address - Street 1:20 P G A DR STE 203
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8218
Practice Address - Country:US
Practice Address - Phone:540-370-1600
Practice Address - Fax:540-370-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06797Medicare ID - Type UnspecifiedMEDICARE GROUP ID
VADF0862Medicare ID - Type UnspecifiedRR MEDICARE GROUP #