Provider Demographics
NPI:1962413765
Name:SPECIALIZED ORTHOPAEDIC SERVICES,INC.
Entity type:Organization
Organization Name:SPECIALIZED ORTHOPAEDIC SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN (JAY)
Authorized Official - Middle Name:R
Authorized Official - Last Name:KURELICH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:703-281-1200
Mailing Address - Street 1:307 MAPLE AVE WEST
Mailing Address - Street 2:BUILDING F
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4307
Mailing Address - Country:US
Mailing Address - Phone:703-281-1200
Mailing Address - Fax:703-281-1201
Practice Address - Street 1:307 MAPLE AVE WEST
Practice Address - Street 2:BUILDING F
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4307
Practice Address - Country:US
Practice Address - Phone:703-281-1200
Practice Address - Fax:703-281-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1114332BC3200X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
272601OtherANTHEM BCBS
G562OtherCAREFIRST
VA010061300Medicaid
036316600OtherDC MEDICAID
150078000OtherDEPT OF LABOR
036316600OtherDC MEDICAID
=========OtherHEALTHNET
VA0787760001Medicare NSC