Provider Demographics
NPI:1679659403
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:PHR
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:2006-10-27
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000601231H00000X
235Z00000X
VA2101001443237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0007926527OtherAETNA
VA0007768446OtherAETNA
VA7088632OtherAETNA
VA195182OtherANTHEM
VA297809OtherMAMSI
VA0007790506OtherAETNA
VA004978331Medicaid
VA010319544Medicaid
VA282756OtherMAMSI
VA010197554Medicaid
VA240052OtherMAMSI
VA384444OtherANTHEM
VA240052OtherAETNA
VA010319544Medicaid