Healthcare Provider Details

I. General information

NPI: 1053340281
Provider Name (Legal Business Name): ACADEMIC PRIMARY CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1691 INNOVATION DR STE 2100
BLACKSBURG VA
24060-6828
US

IV. Provider business mailing address

1691 INNOVATION DR STE 2100
BLACKSBURG VA
24060-6618
US

V. Phone/Fax

Practice location:
  • Phone: 540-232-8405
  • Fax: 540-232-8429
Mailing address:
  • Phone: 540-232-8405
  • Fax: 540-232-8429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: WARD STEVENS
Title or Position: DIRECTOR
Credential:
Phone: 540-232-8405