Provider Demographics
NPI:1053691964
Name:ORTHOPEDIC SPECIALTY CLINIC, LTD
Entity type:Organization
Organization Name:ORTHOPEDIC SPECIALTY CLINIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MAHEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-361-1830
Mailing Address - Street 1:2800 WELLFORD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3176
Mailing Address - Country:US
Mailing Address - Phone:540-361-1830
Mailing Address - Fax:540-361-1829
Practice Address - Street 1:9530 COSNER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7760
Practice Address - Country:US
Practice Address - Phone:540-361-1830
Practice Address - Fax:540-361-1829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06012Medicare PIN