=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275613473
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENDOCRINOLOGY ASSOCIATES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 11/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3501 COLONIAL GREEN CIR SW
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24018-3752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-344-3276
-----------------------------------------------------
Fax | 540-342-4399
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3501 COLONIAL GREEN CIR SW
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24018-3752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-344-3276
-----------------------------------------------------
Fax | 540-342-4399
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CARL H BIVENS JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 540-344-3276
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------