Provider Demographics
NPI:1578155610
Name:RAY TUCK D.C.,P.C.
Entity Type:Organization
Organization Name:RAY TUCK D.C.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING & CLAIMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-951-6900
Mailing Address - Street 1:1901 S MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6628
Mailing Address - Country:US
Mailing Address - Phone:540-951-6900
Mailing Address - Fax:540-951-8900
Practice Address - Street 1:872 LEE HWY
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-8691
Practice Address - Country:US
Practice Address - Phone:540-966-6485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAY TUCK D.C.,P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty