Healthcare Provider Details

I. General information

NPI: 1457332942
Provider Name (Legal Business Name): ROANOKE CITY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 8TH ST SW
ROANOKE VA
24016-3529
US

IV. Provider business mailing address

515 8TH ST SW
ROANOKE VA
24016-3529
US

V. Phone/Fax

Practice location:
  • Phone: 540-857-7600
  • Fax:
Mailing address:
  • Phone: 540-857-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number0101033209
License Number StateVA

VIII. Authorized Official

Name: DR. MOLLY ODELL
Title or Position: HEALTH DIRECTOR
Credential: M.D.
Phone: 540-857-7600