MEDICARE: BLUE RIDGE VASCULAR & ENDOVASCULAR INSTITUTE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician

General Provider Information

NPI Number	:	1598621633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE RIDGE VASCULAR & ENDOVASCULAR INSTITUTE LLC

Provider Business Mailing Address
First Line	:	PO BOX 8310
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-0310
Country	:	US
Telephone Number	:	540-345-3556
Fax Number	:	540-400-6858

Provider Business Practice Location Address
First Line	:	4437 STARKEY RD STE B
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-0618
Country	:	US
Telephone Number	:	540-345-3556
Fax Number	:	540-400-6858

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSHUA ADAMS
Credential	:	MD
Telephone Number	:	540-345-3556

Provider Enumeration Date	:	01/02/2026
Last Update Date	:	01/02/2026

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