Provider Demographics
NPI:1114110889
Name:ROANOKE VALLEY HEALTH SERVICES INC
Entity Type:Organization
Organization Name:ROANOKE VALLEY HEALTH SERVICES INC
Other - Org Name:ROANOKE VALLEY CARDIAC & VASCULAR DISEASE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE - MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-535-8005
Mailing Address - Street 1:3120 WELLONS BLVD
Mailing Address - Street 2:PO BOX 15409
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5247
Mailing Address - Country:US
Mailing Address - Phone:252-672-7732
Mailing Address - Fax:252-635-6951
Practice Address - Street 1:250 SMITH CHURCH RD
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4914
Practice Address - Country:US
Practice Address - Phone:252-672-7732
Practice Address - Fax:252-635-6951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC020C2OtherNC BLUE CROSS BLUE SHIELD
NC5908753Medicaid
NC230728DMedicare PIN