Provider Demographics
NPI:1336286392
Name:ROANOKE ORTHOPEDIC APPLIANCE CO INC
Entity Type:Organization
Organization Name:ROANOKE ORTHOPEDIC APPLIANCE CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP SEC
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MOTLEY
Authorized Official - Last Name:O BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:SURGICAL APPLIANCE T
Authorized Official - Phone:540-427-3088
Mailing Address - Street 1:1105 PIEDMONT ST SE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014
Mailing Address - Country:US
Mailing Address - Phone:540-427-3088
Mailing Address - Fax:540-427-5942
Practice Address - Street 1:1105 PIEDMONT ST SE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014
Practice Address - Country:US
Practice Address - Phone:540-427-3088
Practice Address - Fax:540-427-5942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0925332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA260295OtherANTHEM BC & BS
0437460001Medicare ID - Type Unspecified