1205963907 NPI number — ROANOKE ORTHOPAEDIC CENTER, INC.

Table of content: (NPI 1205963907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205963907 NPI number — ROANOKE ORTHOPAEDIC CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROANOKE ORTHOPAEDIC CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205963907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4064 POSTAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24018-6438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-776-0200
Provider Business Mailing Address Fax Number:
540-777-5850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 ELECTRIC RD
Provider Second Line Business Practice Location Address:
SUITE 1040
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24153-7474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-776-0200
Provider Business Practice Location Address Fax Number:
540-767-0381
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAGAN
Authorized Official First Name:
HUGH
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT--ORTHOPAEDIC SURGEON
Authorized Official Telephone Number:
540-776-0200

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CB4578 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0466200004 . This is a "DMEPOS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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