Provider Demographics
NPI:1124188651
Name:ROANOKE MEDICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:ROANOKE MEDICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:SKAHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-792-0022
Mailing Address - Street 1:239 GREEN SREET
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-2156
Mailing Address - Country:US
Mailing Address - Phone:252-792-0022
Mailing Address - Fax:252-792-0027
Practice Address - Street 1:239 GREEN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2000
Practice Address - Country:US
Practice Address - Phone:252-792-0022
Practice Address - Fax:252-792-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200174207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132V0Medicaid
NC132V0OtherBCBS GROUP NUMBER
NC2000864AMedicare ID - Type Unspecified
NC89132V0Medicaid