NPIMap

Organization Active NPI

Chippenham & Johnston Willis Sports Medicine, LLC

Doing business as CJW Sports Medicine, LLC

  • Sports Medicine (Family Medicine) Physician
  • North Chesterfield, VA
National Provider Identifier
1639448962
Registry record updated Dec 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
Legal business name
CHIPPENHAM & JOHNSTON WILLIS SPORTS MEDICINE, LLC
Doing business as
CJW Sports Medicine, LLC
Practice address
1115 Boulders Pkwy
Suite 110
North Chesterfield, VA 23225-4067
Phone
(804) 560-6500
Fax
(804) 560-6505
NPI assigned
Dec 15, 2011
Last updated
Dec 15, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Hunter L. Durvin, ATC
Title
Practice Manager
Phone
(804) 560-6511

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X Primary

Addresses

Primary practice location

1115 Boulders Pkwy
Suite 110
North Chesterfield, VA 23225-4067

Mailing address

1115 Boulders Pkwy
Suite 110
North Chesterfield, VA 23225-4067
Phone (804) 560-6500

Other names 1

  • CJW Sports Medicine, LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Chippenham Johnston Willis Sports Medicine LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323907200000",
    "number": "1639448962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 BOULDERS PKWY",
            "address_2": "SUITE 110",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232254067",
            "telephone_number": "804-560-6500",
            "fax_number": "804-560-6505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 BOULDERS PKWY",
            "address_2": "SUITE 110",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232254067",
            "telephone_number": "804-560-6500",
            "fax_number": "804-560-6505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIPPENHAM & JOHNSTON WILLIS SPORTS MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-15",
        "last_updated": "2011-12-15",
        "status": "A",
        "authorized_official_last_name": "DURVIN",
        "authorized_official_first_name": "HUNTER",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "804-560-6511",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ATC"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CJW Sports Medicine, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Chesterfield, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.