Provider Demographics
NPI:1124450135
Name:VB ORTHOPAEDICS PA
Entity type:Organization
Organization Name:VB ORTHOPAEDICS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:VANDEN BERGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-968-0292
Mailing Address - Street 1:P.O. BOX 2576
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-0043
Mailing Address - Country:US
Mailing Address - Phone:254-968-0292
Mailing Address - Fax:888-289-1607
Practice Address - Street 1:351 E TARLETON ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-3511
Practice Address - Country:US
Practice Address - Phone:254-968-0292
Practice Address - Fax:888-289-1607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2329207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX332614201Medicaid