Healthcare Provider Details

I. General information

NPI: 1679570238
Provider Name (Legal Business Name): VIRGINIA PROSTHETICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4338 WILLIAMSON RD NW
ROANOKE VA
24012-2821
US

IV. Provider business mailing address

4338 WILLIAMSON RD NW
ROANOKE VA
24012-2821
US

V. Phone/Fax

Practice location:
  • Phone: 540-366-8287
  • Fax: 540-366-0186
Mailing address:
  • Phone: 540-366-8287
  • Fax: 540-366-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELISSA D EDWARDS
Title or Position: BUSINESS OPERATIONS MANAGER
Credential:
Phone: 540-366-8287