Provider Demographics
NPI:1841241536
Name:ROANOKE VALLEY SURGICAL ASSOC
Entity Type:Organization
Organization Name:ROANOKE VALLEY SURGICAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:W
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-537-1933
Mailing Address - Street 1:97 HIGHWAY 125
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870
Mailing Address - Country:US
Mailing Address - Phone:252-537-1933
Mailing Address - Fax:252-537-1936
Practice Address - Street 1:97 HIGHWAY 125
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870
Practice Address - Country:US
Practice Address - Phone:252-537-1933
Practice Address - Fax:252-537-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23812208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
458663113OtherCHAMPUS
NC890222AMedicaid
020015092OtherRAILROAD MEDICARE
NC0222AOtherBCBS
020015092OtherRAILROAD MEDICARE
NC2310734Medicare ID - Type Unspecified