Provider Demographics
NPI:1386837250
Name:ROANOKE VALLEY SPEECH AND HEARING CENTER, INC.
Entity Type:Organization
Organization Name:ROANOKE VALLEY SPEECH AND HEARING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:J.
Authorized Official - Middle Name:ANDREE'
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-343-0165
Mailing Address - Street 1:2030 COLONIAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-3204
Mailing Address - Country:US
Mailing Address - Phone:540-343-0165
Mailing Address - Fax:540-345-4664
Practice Address - Street 1:2030 COLONIAL AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-3204
Practice Address - Country:US
Practice Address - Phone:540-343-0165
Practice Address - Fax:540-345-4664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000601231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA247018OtherANTHEM
VA7602827OtherAETNA
VA=========OtherUNITED HEALTHCARE