Healthcare Provider Details

I. General information

NPI: 1316097082
Provider Name (Legal Business Name): ROANOKE HEALTHCARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 MEDICAL DR SUITE 7
ROANOKE AL
36274-2421
US

IV. Provider business mailing address

PO BOX 473
ROANOKE AL
36274-0473
US

V. Phone/Fax

Practice location:
  • Phone: 334-863-2311
  • Fax: 334-863-5596
Mailing address:
  • Phone: 334-863-2311
  • Fax: 334-863-5596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY HARLIN
Title or Position: CEO
Credential:
Phone: 334-863-4111