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General NPI Number Information
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NPI Number | 1275924318
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Entity Type | Organization
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Legal Business Name | VALLEY INTEGRATIVE MEDICINE
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Dates
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Enumeration Date | 02/11/2015
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Last Update Date | 07/24/2015
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Provider Practice Location Address
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Address Line | 2702 BRAMBLETON AVE SW
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City | ROANOKE
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State | VA
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Zip | 24015-5139
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Country | US
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Telephone | 540-556-1061
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Fax |
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Provider Business Mailing Address
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Address Line | 2702 BRAMBLETON AVE SW
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City | ROANOKE
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State | VA
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Zip | 24015-4308
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Country | US
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Telephone | 540-556-1061
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Fax |
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Authorized Official
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Title or Position | ASSISTANT PROFESSOR
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Name | DR. ALICIA G HOLLIS
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Credential | D.O.
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Telephone | 540-556-1061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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