Provider Demographics
NPI:1720198369
Name:ROANOKE VALLEY HEALTH SERVICES INC
Entity Type:Organization
Organization Name:ROANOKE VALLEY HEALTH SERVICES INC
Other - Org Name:ROANOKE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:BARNES
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-535-8159
Mailing Address - Street 1:1385 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-5130
Mailing Address - Country:US
Mailing Address - Phone:252-537-9176
Mailing Address - Fax:252-537-6851
Practice Address - Street 1:1385 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-5130
Practice Address - Country:US
Practice Address - Phone:252-537-9176
Practice Address - Fax:252-537-6851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC348941AMedicaid
NC348941Medicare Oscar/Certification
NC230728Medicare PIN