Healthcare Provider Details

I. General information

NPI: 1558307116
Provider Name (Legal Business Name): ROANOKE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 HWY 64 EAST
PLYMOUTH NC
27962
US

IV. Provider business mailing address

PO BOX 1026
PLYMOUTH NC
27962-1026
US

V. Phone/Fax

Practice location:
  • Phone: 252-793-4500
  • Fax: 252-793-2079
Mailing address:
  • Phone: 252-793-4500
  • Fax: 252-793-2079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number22192
License Number StateNC

VIII. Authorized Official

Name: DR. ROBERT LEE VENABLE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 252-793-4500