Provider Demographics
NPI:1164612974
Name:BOXLEY HILL CLINIC INC
Entity Type:Organization
Organization Name:BOXLEY HILL CLINIC INC
Other - Org Name:ROBERT S LUCAS MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-362-1616
Mailing Address - Street 1:5501 WILLIAMSON RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-1439
Mailing Address - Country:US
Mailing Address - Phone:540-362-1616
Mailing Address - Fax:540-362-8234
Practice Address - Street 1:5501 WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-1439
Practice Address - Country:US
Practice Address - Phone:540-362-1616
Practice Address - Fax:540-362-8234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA394048OtherANTHEM
VACB0245OtherMEDICARE RAILROAD
VA394048OtherANTHEM