Healthcare Provider Details

I. General information

NPI: 1710667381
Provider Name (Legal Business Name): PARISH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 CAMPBELL AVE SW STE B
ROANOKE VA
24016-3534
US

IV. Provider business mailing address

1146 BELCROFT CT
ROANOKE VA
24018-7709
US

V. Phone/Fax

Practice location:
  • Phone: 818-640-9454
  • Fax:
Mailing address:
  • Phone: 818-640-9454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT GERSTEIN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 818-640-9454