COLLIVER SPORTS AND SPINE INC (NPI# 1295196772) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295196772 |
| Entity Type | Organization |
| Organization Name | COLLIVER SPORTS AND SPINE INC |
| Other Organization Name | VALLEY SPORTS AND SPINE CLINIC |
| Practice Address |
3706 S Main St Suite D Blacksburg VA 24060-7006 |
| Practice Telephone | 5404433832 |
| Practice Fax Number | 5404439362 |
| Enumeration Date | 2016-03-11 |
| Last Update Date | 2016-03-11 |
| Authorized Official Name | ETHAN B COLLIVER (PRESIDENT) |
| Authorized Official Telephone | 5404433832 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
0102202357 | VA | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Valley Sports and Spine Clinic | Doing Business As Name - Organization |
| Street Address |
3706 S MAIN ST SUITE D |
| City | BLACKSBURG |
| State | VA |
| Zip Code | 24060-7006 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053385922 | Richard L Wilson Jr. | Physical Medicine & Rehabilitation | 3706 S Main St, Suite A, Blacksburg, VA 24060-7006 | 2006-02-15 |
| 1003395914 | Catherine Lee | Physician Assistant | 3706 S Main St, Blacksburg, VA 24060-7006 | 2018-08-10 |
| 1134529902 | Melanie Schano | Nurse Practitioner | 3706 S Main St, Suite B, Blacksburg, VA 24060-7006 | 2014-08-29 |
| 1588949234 | Valley Skin Specialists | Dermatology | 3706 S Main St, Suite B, Blacksburg, VA 24060-7006 | 2011-10-13 |
| 1740572205 | Ethan B. Colliver D.o. Pllc | Physical Medicine & Rehabilitation | 3706 S Main St, Blacksburg, VA 24060-7006 | 2011-05-03 |
| 1679801500 | Aleksandra G Brown | Dermatology | 3706 S Main St, Suite B, Blacksburg, VA 24060-7006 | 2009-12-04 |
| 1932306388 | Ability Physical Medicine and Rehabilitation Inc | Specialist | 3706 S Main St, Suite A, Blacksburg, VA 24060-7006 | 2007-06-29 |
| 1962441212 | Chad Jamison Johnston | Dermatology | 3706 S Main St, Suite B, Blacksburg, VA 24060-7006 | 2006-06-05 |
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| 1720568637 | Amy Butler | Nurse Practitioner | Blue Ridge Cancer Center, 2955 Research Drive, Blacksburg, VA 24060 | 2018-08-20 |
| 1134615321 | Benjamin Toliver Matthews | Dentist | 1400 S. Main St, Ste 1, Blacksburg, VA 24060 | 2018-07-10 |
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| 1316333685 | Access and Mobility | Durable Medical Equipment & Medical Supplies | 2536 Blossom Trail West, Blackburg, VA 24060 | 2015-04-13 |
| 1326485202 | Kristopher Joel Hansen | Internal Medicine | 2600 Research Center Dr Ste A, Blacksburg, VA 24060 | 2013-05-31 |
| 1891038949 | Holly P. Martin | Physician Assistant | 3706 South Main Street, Suite D, Blacksburg, VA 24060 | 2013-03-27 |
| 1174875330 | Catawba Hospital | Chronic Disease Hospital | 1801 Glade Road, Blacksburg, VA 24060 | 2012-10-11 |
| 1083964316 | Karla Sue Soukup | Marriage & Family Therapist | 510 S. Main Street, Blackburg, VA 24060 | 2012-09-13 |
| Find all providers in zip 24060 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
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|---|---|---|---|---|
| 1396118543 | Stillpoint Osteopathic Medicine | Clinic/Center | 1999 S Main St, Suite 305-a, Blacksburg, VA 24060-6634 | 2015-11-10 |
| 1598058729 | Farhi Eye Care & Surgery Specialists, LLC | Clinic/Center | 1901 S Main St, Unit 1, Blacksburg, VA 24060-6600 | 2011-05-20 |
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| 1356677306 | Hwang H. Junn Md Im/geri Plc | Clinic/Center | 4216 Evergreen Lane, Suite 111, Annandale, VA 22003-3253 | 2009-10-27 |
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| City | BLACKSBURG |
| Zip Code | 24060 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.