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General NPI Number Information
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NPI Number | 1396157459
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Entity Type | Organization
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Legal Business Name | ROCKWELL PHYSICIANS OF SALISBURY
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Dates
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Enumeration Date | 05/23/2014
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Last Update Date | 05/23/2014
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Provider Practice Location Address
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Address Line | 2891 ANDERSON HWY
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City | POWHATAN
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State | VA
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Zip | 23139-7406
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Country | US
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Telephone | 804-897-1259
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Fax |
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Provider Business Mailing Address
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Address Line | 2891 ANDERSON HWY
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City | POWHATAN
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State | VA
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Zip | 23139-7406
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. LARA RUSSELL
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Credential |
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Telephone | 804-897-6140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101049541
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License Number State | VA
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