Provider Demographics
NPI:1467117267
Name:JRG OF VIRGINIA LLC
Entity Type:Organization
Organization Name:JRG OF VIRGINIA LLC
Other - Org Name:JOINT REGENERATION GROUP OF VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:CAMPAGNOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-900-5633
Mailing Address - Street 1:1315 2ND ST SW STE 103
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4935
Mailing Address - Country:US
Mailing Address - Phone:540-900-5633
Mailing Address - Fax:540-730-7780
Practice Address - Street 1:1315 2ND ST SW STE 103
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4935
Practice Address - Country:US
Practice Address - Phone:540-900-5633
Practice Address - Fax:540-730-7780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-05
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty