Provider Demographics
NPI:1659318525
Name:ROYAL OAK MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:ROYAL OAK MEDICAL ASSOCIATES PC
Other - Org Name:FAMILY PHYSICIANS OF MARION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:CLAMPITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-782-9751
Mailing Address - Street 1:1020 TERRACE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4392
Mailing Address - Country:US
Mailing Address - Phone:276-783-7167
Mailing Address - Fax:276-783-6432
Practice Address - Street 1:1020 TERRACE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4392
Practice Address - Country:US
Practice Address - Phone:276-783-7167
Practice Address - Fax:276-783-6432
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROYAL OAK MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-01
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA240906OtherANTHEM GROUP
VA2023362500OtherBLACK LUNG
VACD6056OtherRR MEDICARE
VA240906OtherANTHEM GROUP