Healthcare Provider Details

I. General information

NPI: 1962320077
Provider Name (Legal Business Name): ROANOKE PREMIER MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3565 ELECTRIC RD STE G
ROANOKE VA
24018-4452
US

IV. Provider business mailing address

PO BOX 8310
ROANOKE VA
24014-0310
US

V. Phone/Fax

Practice location:
  • Phone: 540-345-3556
  • Fax:
Mailing address:
  • Phone: 540-345-3556
  • Fax:

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: SCOTT HARRISON
Title or Position: OWNER
Credential: MD
Phone: 540-345-3556