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General NPI Number Information
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NPI Number | 1114667110
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Entity Type | Organization
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Legal Business Name | MIZELLORE MEDICAL SOLUTIONS LLC
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Dates
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Enumeration Date | 03/30/2022
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Last Update Date | 03/30/2022
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Provider Practice Location Address
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Address Line | 3755 WILMONT AVE NW
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City | ROANOKE
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State | VA
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Zip | 24017-6509
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Country | US
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Telephone | 540-494-4457
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Fax |
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Provider Business Mailing Address
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Address Line | 4727 VALLEY VIEW BLVD NW # 1061
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City | ROANOKE
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State | VA
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Zip | 24012-2000
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Country | US
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Telephone | 540-494-4457
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MIZELLORE LEXIMA
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Credential | RN
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Telephone | 540-494-4457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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