Provider Demographics
NPI:1831102987
Name:VIRGINIA PROSTHETICS INC
Entity type:Organization
Organization Name:VIRGINIA PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-366-8287
Mailing Address - Street 1:4338 WILLIAMSON RD NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-2821
Mailing Address - Country:US
Mailing Address - Phone:540-366-8287
Mailing Address - Fax:540-366-0186
Practice Address - Street 1:103 S PANTOPS DR STE 107
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8617
Practice Address - Country:US
Practice Address - Phone:434-220-2426
Practice Address - Fax:434-220-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010313538Medicaid
VA010313538Medicaid