Healthcare Provider Details

I. General information

NPI: 1114799590
Provider Name (Legal Business Name): PREMIER TELEHEALTH SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 PETERS CREEK RD STE 110
ROANOKE VA
24019-4060
US

IV. Provider business mailing address

6701 PETERS CREEK RD STE 110
ROANOKE VA
24019-4060
US

V. Phone/Fax

Practice location:
  • Phone: 800-765-7130
  • Fax: 888-500-1891
Mailing address:
  • Phone: 800-765-7130
  • Fax: 888-500-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY GOAD
Title or Position: DIRECTOR
Credential: DO
Phone: 540-488-2200