Provider Demographics
NPI:1497859730
Name:CITY OF ROANOKE
Entity Type:Organization
Organization Name:CITY OF ROANOKE
Other - Org Name:ROANOKE FIRE-EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-853-6499
Mailing Address - Street 1:PO BOX 715900
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19171-5900
Mailing Address - Country:US
Mailing Address - Phone:844-368-2789
Mailing Address - Fax:888-974-1293
Practice Address - Street 1:713 3RD ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4009
Practice Address - Country:US
Practice Address - Phone:540-853-6499
Practice Address - Fax:540-853-2458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA000433416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA064083OtherBLUE SHIELD
VA009011978Medicaid