Provider Demographics
NPI:1821021858
Name:ROANOKE ORTHOPAEDIC CENTER, INC.
Entity Type:Organization
Organization Name:ROANOKE ORTHOPAEDIC CENTER, INC.
Other - Org Name:ROANOKE ORTHOPAEDIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ORTHOPAEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAGAN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:540-776-0200
Mailing Address - Street 1:PO BOX 21369
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0546
Mailing Address - Country:US
Mailing Address - Phone:540-776-0200
Mailing Address - Fax:540-777-5850
Practice Address - Street 1:4064 POSTAL DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6438
Practice Address - Country:US
Practice Address - Phone:540-776-0200
Practice Address - Fax:540-777-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACB4578OtherRAILROAD MEDICARE
VAC00304Medicare PIN
VA0466200001Medicare NSC